Teriparatide belongs to a family of medications known as bone formation agents. This medication is used to treat severe osteoporosis (bone loss) in postmenopausal women and in men. Teriparatide is usually used when other treatments for osteoporosis have not worked or have caused unacceptable side effects.

It is also used to treat osteoporosis associated with long-term use of corticosteroid medications in men and women who are at increased risk for bone fracture. Teriparatide works by increasing new bone formation faster than old bone is lost, making bones stronger and less likely to break.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

The recommended dose is 20 µg (micrograms) once a day. Teriparatide should only be given as a subcutaneous (under the skin) injection into the thigh or stomach area.

Teriparatide is given using a replaceable cartridge that fits into an injection device (pen). You or your caregiver should receive appropriate training and instruction on the proper use of the pen from a doctor, nurse, or pharmacist. Improper use of the pen may result in inaccurate dosing. Each cartridge can be used up to 28 days and should not be removed from the pen until the 28 days have passed, at which point the cartridge should be removed from the pen and thrown away, even if it still has some medication remaining. Place a new cartridge in the pen and refrigerate.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor. If you forget or are unable to use this medication at your usual time, skip the missed dose and continue with your usual dosing schedule. Do not inject a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store the pen and new cartridges in the refrigerator at 2°C to 8°C. Do not freeze, and do not use a cartridge if the solution has been frozen. Do not use the solution if it is cloudy or coloured, if there are solid particles in the solution, or if it is past the expiry date.

Each mL of sterile, colourless, clear solution contains 250 µg of teriparatide. Nonmedicinal ingredients: acetic acid (glacial), mannitol, metacresol, hydrochloric acid (for pH adjustment), sodium acetate (trihydrate), sodium hydroxide (for pH adjustment), and water for injection.

Do not use teriparatide if you:

• are allergic to teriparatide or any ingredients of this medication
• are a child or growing adult
• are pregnant or breast-feeding
• have bone cancer, or have cancer from other parts of the body that has spread to the bone
• have had prior external beam or implant radiation therapy involving bones
• have high blood calcium
• have other bone diseases such as hyperparathyroidism and Paget's disease
• have severe kidney problems
• have unexplained high alkaline phosphatase levels

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who uses this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people using this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• constipation (temporary)
• cough
• diarrhea
• dizziness
• headache
• heartburn
• high blood pressure
• increased sweating
• joint pain
• leg cramps
• nausea (temporary)
• pain
• runny nose
• sore throat
• trouble sleeping
• vomiting (temporary)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• chest pain
• fainting
• mood changes
• skin rash
• symptoms of high calcium levels:
  • constipation
  • continuing nausea
  • low energy
  • muscle weakness
  • vomiting

Stop taking the medication and seek immediate medical attention if any of the following occur:

• symptoms of a severe allergic reaction:
  • difficulty breathing
  • hives
  • swelling of the mouth or throat

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood and urine calcium levels: While using this medication you will need to have blood and urine tests to make sure your calcium levels are within the normal range. If you experience symptoms of high calcium levels (e.g., nausea, vomiting, constipation, muscle weakness, low energy), contact your doctor immediately.

Duration of treatment: The safety and effectiveness of using teriparatide for longer than 24 months have not been established.

Kidney or bladder stones: If you have, or have had, kidney or bladder stones discuss with your doctor how this medication may affect your medical condition and whether any special monitoring is needed.

Kidney function: If you have moderately to severely reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood pressure: Teriparatide can cause a temporary drop in blood pressure within 4 hours of taking this medication. If you feel dizzy or lightheaded after the injection, sit down or lie down until you are feeling better. Usually these symptoms go away within a few minutes to a few hours. If symptoms don't go away or become worse, contact your doctor immediately. Do not drive or operate machinery until any dizziness and lightheadedness goes away.

Other osteoporosis treatment and prevention measures: Talk to your doctor about whether other osteoporosis treatment and prevention measures are suitable for you. These measures include calcium or vitamin D supplements, weight-bearing exercise, and modifying smoking, alcohol or coffee use.

Pregnancy: Teriparatide should not be used by pregnant women. Women who could become pregnant while using this medication should use effective methods of birth control. If you become pregnant while using this medication, stop using teriparatide and contact your doctor immediately.

Breast-feeding: It is not known if teriparatide passes into breast milk. Women who are breast-feeding should not use this medication.

Children and adolescents: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between teriparatide and any of the following:

• digoxin
• furosemide
• hydrochlorothiazide

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.