Teriparatide Dosage and Route of Administration

The recommended dosage of teriparatide is 20 mcg administered once daily as a subcutaneous injection into the thigh or abdominal region. 1

Dosage Information

Teriparatide (Forteo) is available as a 620 mcg/2.48 mL (250 mcg/mL) single-patient-use pen containing 28 daily doses of 20 mcg 1
The standard therapeutic dose is 20 mcg administered subcutaneously once daily 2, 1
No dosage adjustment is required based on age, but caution should be used in patients with renal impairment 1
The medication should be administered initially under circumstances where the patient can sit or lie down if symptoms of orthostatic hypotension occur 1

Teriparatide must be administered as a subcutaneous injection 1
Preferred injection sites include the thigh or abdominal region 1
The medication requires refrigeration for storage of the prefilled syringes/pens 3
Daily subcutaneous injections are required, which may affect patient adherence 3

Treatment duration should not exceed 2 years during a patient's lifetime 1
Extended use beyond 2 years should only be considered if a patient remains at or has returned to having a high risk for fracture 1
The time-limited use is related to historical concerns about osteosarcoma risk in animal studies 2, 4

Calcium (1,000-1,200 mg/day) and vitamin D (600-800 IU/day; serum level ≥20 ng/ml) supplementation should be considered based on individual patient needs 2, 1
Optimizing calcium and vitamin D intake is recommended for all patients receiving teriparatide treatment 2

For women of childbearing potential who require osteoporosis treatment but are not planning pregnancy during the treatment period, teriparatide is considered a second-line option after oral bisphosphonates 2
In glucocorticoid-induced osteoporosis, teriparatide is recommended after oral bisphosphonates when they are not appropriate 2, 4
Teriparatide should be used with caution in patients with a history of cardiovascular disease, especially those with pre-existing arrhythmias 5

After subcutaneous injection of the 20 mcg daily dose, teriparatide reaches peak blood levels very rapidly (median tmax = 0.25 hr) 6
The medication has a short half-life (mean t1/2 = 0.708 hr), disappearing quickly from the blood 6
This pharmacokinetic profile produces a rapid increase in bone formation markers followed by a later increase in bone resorption markers, creating what is described as a "bone anabolic window" 6

Initial administration should be done where the patient can sit or lie down if orthostatic hypotension occurs 1
Monitoring for hypercalcemia may be necessary, particularly in patients with underlying hypercalcemic disorders 1
Patients with active or recent urolithiasis should be monitored due to risk of exacerbation 1

Hypersensitivity to teriparatide or to any of its excipients 1
Caution in patients with increased risk of osteosarcoma including those with open epiphyses, metabolic bone diseases, bone metastases, prior radiation therapy involving the skeleton, or hereditary disorders predisposing to osteosarcoma 1
Not recommended for patients with cancer or history of malignancy prone to metastasize to bone 4