Drug reference

Teriparatide

Recombinant parathyroid hormone analogue (PTH 1-34) · Disorders of bone metabolism

START

20 mcg SC once daily (thigh/abdomen); give first doses where patient can sit/lie (orthostasis)

TYPICAL MAX

20 mcg/day; limit total treatment duration per current guidance

STOP IF

Persistent hypercalcaemia, suspected osteosarcoma symptoms, severe orthostatic syncope

WATCH

Serum calcium (pre-dose), orthostatic symptoms early, sequential transition to antiresorptive after course

CDSCO approvedATC H05AA02

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 15min · SC absorption
PEAK: 30min · SC Cmax
t½: 1h · SC t½
DURATION: 1d · once-daily pulse

EXCRETION

Proteolysis; renal peptide fragments

route + CYP

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

Not indicated/avoid in pregnancy (osteoporosis therapy not for pregnant women)

FDA category + note

Top interactionssee all 5 →

DigoxinSevereDatabaseKimi deep-research + Cla

Available in India

23 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Intermittent daily PTH(1-34) receptor activation preferentially stimulates osteoblastic bone formation over resorption (anabolic), increasing bone mass, trabecular connectivity and strength.

Indications

Severe osteoporosis at high fracture risk (postmenopausal women, men, glucocorticoid-induced)Patients intolerant of/failed other osteoporosis therapy

Dosing

Adult: 20 mcg subcutaneously once daily (thigh/abdomen). Cumulative lifetime use limited (historically ≤2 years).
Pediatric: Contraindicated (open epiphyses — osteosarcoma risk).
Renal adjustment: Severe renal impairment: use with caution (hypercalcaemia risk).
Hepatic adjustment: No specific adjustment.
Geriatric: No specific adjustment; orthostatic hypotension on first doses.
Max dose: 20 mcg/day

Pharmacokinetics

Onset

Bone formation markers rise within ~1 month

Peak effect

SC Cmax ~30 min; transient

Duration

Once-daily pulse (transient exposure intended)

Half-life

SC ~1 h (IV ~5 min)

Bioavailability

SC ~95%

Protein binding

Not significant

Metabolism

Non-specific hepatic/peripheral proteolysis

Excretion

Renal (peptide fragments)

Contraindications

Conditions with increased baseline osteosarcoma risk (Paget disease, prior skeletal radiation, unexplained raised alkaline phosphatase, open epiphyses)
Bone metastases / skeletal malignancy
Pre-existing hypercalcaemia
Severe renal impairment (caution)
Hypersensitivity to teriparatide

Side effects

Common

Transient orthostatic hypotension/dizziness (early doses)NauseaArthralgia, leg crampsInjection-site reactionsTransient hypercalcaemia (mild)

Serious

Osteosarcoma (rat signal; rare in humans — historical boxed warning, removed 2020 in US)
Symptomatic hypercalcaemia
Severe orthostatic hypotension/syncope (first doses)
Nephrolithiasis (pre-existing); digoxin toxicity via hypercalcaemia