Teriparatide

What is Teriparatide

Teriparatide is recombinant parathyroid hormone, identical to the 34 N-terminal amino acids of human parathyroid hormone (PTH).

This amino terminal chain of PTH appears to be responsible for its chief biologic effects,

including the regulation of calcium at the bone. In addition to reducing bone turnover as other treatments for osteoporosis do, teriparatide stimulates the formation of new bone and increases bone mass.

Teriparatide reduces the incidence of new vertebral and nonvertebral fragility fractures in osteoporotic patients; it is under investigation to determine if it may speed bone healing in slow to heal fractures and for idiopathic and acquired hypoparathyroidism.

However, an increase in the incidence of osteosarcoma in rats treated with teriparatide has been seen (see Contraindications and Adverse Reactions), which may limit its use. Use for the treatment of osteoporosis is recommended only in patients at a high risk of fracture, which is defined as those with history of osteoporotic fracture, those with multiple risk factors for fracture, or patients who have failed or are intolerant to other available osteoporosis therapy.

According to the North American Menopause Society, teriparatide use in postmenopausal women with osteoporosis should be reserved for those patients with a high risk of fracture who do not have hypercalcemia, bone metastases, any bone tumor-predisposing disorder, or a history of skeletal irradiation.

Teriparatide was granted orphan drug status in January 1987 for use as a diagnostic agent to assist in differentiating between hypocalcemia due to hypoparathyroidism and hypocalcemia due to pseudohypoparathyroidism.

Teriparatide was approved for the treatment of osteoporosis in November 2002 and glucocorticoid-induced osteoporosis in July 2009.

Brand Name

Forteo

Indications

  • hypoparathyroidism
  • osteoporosis

Side Effects

  1. anaphylactic shock
  2. anaphylactoid reactions
  3. angina
  4. angioedema
  5. antibody formation
  6. arthralgia
  7. asthenia
  8. constipation
  9. cough
  10. depression
  11. diaphoresis
  12. diarrhea
  13. dizziness
  14. dyspepsia
  15. dyspnea
  16. headache
  17. hypercalcemia
  18. hypercalciuria
  19. hypertension
  20. hypomagnesemia
  21. injection site reaction
  22. insomnia
  23. muscle cramps
  24. nausea
  25. new primary malignancy
  26. orthostatic hypotension
  27. osteogenic sarcoma
  28. pharyngitis
  29. phosphaturia
  30. rash
  31. rhinitis
  32. syncope
  33. urticaria
  34. vertigo
  35. vomiting

Monitoring Parameters

  • 24-hour urinary calcium
  • serum calcium
  • serum creatinine/BUN
  • serum intact parathyroid hormone concentrations (iPTH)
  • serum magnesium
  • serum uric acid

Contraindications

  • breast-feeding
  • children
  • hypercalcemia
  • hypercalciuria
  • hyperparathyroidism
  • infants
  • neonates
  • nephrolithiasis
  • new primary malignancy
  • orthostatic hypotension
  • osteogenic sarcoma
  • Paget’s disease
  • pregnancy
  • radiation therapy

Interactions

  • Digoxin
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