Recommended Dose of Teriparatide
The recommended dose of teriparatide is 20 mcg administered subcutaneously once daily into the thigh or abdominal region. 1, 2
Dosing Specifications
- Standard therapeutic dose: 20 mcg subcutaneously once daily 1, 2
- The medication is supplied as 620 mcg/2.48 mL (250 mcg/mL) in a single-patient-use pen containing 28 daily doses of 20 mcg 2
- Administer initially under circumstances where the patient can sit or lie down if symptoms of orthostatic hypotension occur 2
Duration of Treatment
- Treatment duration should not exceed 2 years during a patient's lifetime due to historical concerns about osteosarcoma risk in animal studies 1
- Use of teriparatide for more than 2 years should only be considered if a patient remains at or has returned to having a high risk for fracture 2
- The FDA label notes that the osteosarcoma boxed warning was removed in November 2023, though the 2-year duration recommendation remains 2
Required Supplementation
- Calcium supplementation: 1,000-1,200 mg/day 1
- Vitamin D supplementation: 600-800 IU/day (target serum level ≥20 ng/mL) 1
- Supplemental calcium and vitamin D should be considered based on individual patient needs 1, 2
Pharmacokinetic Profile
- Teriparatide demonstrates rapid absorption with peak concentration achieved within 30 minutes (median tmax = 0.25 hours) 3
- Rapid elimination occurs with a half-life of approximately 1 hour, resulting in total duration of exposure of approximately 4 hours 3
- This produces a transient increase in serum calcium with maximum effect at approximately 4.25 hours (median increase 0.4 mg/dL), returning to predose levels by 16-24 hours 3