Pre-Injection Patient Counseling for Teriparatide
Critical Safety Warnings
Patients must be counseled to sit or lie down immediately after the first few injections, as orthostatic hypotension with dizziness, lightheadedness, or palpitations can occur within 4 hours of administration. 1 This is particularly important during treatment initiation, and patients should remain seated or recumbent until symptoms resolve completely. 1
Osteosarcoma Risk Disclosure
- Inform patients that teriparatide caused osteosarcoma (bone cancer) in rat studies, though no increased risk has been observed in humans treated with teriparatide. 1
- Emphasize that treatment duration must not exceed 2 years during the patient's lifetime due to this theoretical concern. 2, 1
Essential Pre-Treatment Instructions
Calcium and Vitamin D Supplementation
- Ensure patients understand they must take calcium 1,000-1,200 mg daily and vitamin D 600-800 IU daily throughout treatment. 3, 2, 1
- Total daily calcium intake from all sources (diet plus supplements) should be limited to 1,500 mg to minimize hypercalcemia risk. 4
- Verify adequate vitamin D levels (serum level ≥20 ng/mL) before initiating therapy. 2
Hypercalcemia Recognition
- Instruct patients to immediately contact their healthcare provider if they develop persistent symptoms of hypercalcemia: nausea, vomiting, constipation, lethargy, or muscle weakness. 1
- Mild hypercalcemia typically occurs 4-6 hours after injection and usually resolves spontaneously. 5
Device Administration Training
Proper Injection Technique
- Patients must receive hands-on training with the delivery device (pen) before the first dose, including proper needle attachment, dose setting, and injection technique. 1
- Emphasize that the medication must be injected subcutaneously into the thigh or abdomen. 1
- After injecting, patients must hold the injection button down and count slowly to 5 to ensure full dose delivery. 1
Storage and Handling Requirements
- Store the pen in the refrigerator at 2°C to 8°C (36°F to 46°F) at all times with the white cap on. 1
- Remove from refrigerator and inject immediately; minimize time out of refrigeration. 1
- Never freeze teriparatide; discard if frozen. 1
- Discard the pen after 28 days of use, even if medication remains. 1
- Never store the device with a needle attached. 1
Critical Device Safety Points
- Never share the pen or needles with anyone else, as this can spread infection or disease. 1
- Never transfer medication from the pen to a syringe or other device. 1
- Dispose of needles in a puncture-resistant sharps container according to local regulations. 1
- Do not use if the medication appears cloudy, colored, or contains floating particles. 1
Dosing Schedule and Compliance
Daily Administration Requirements
- Inject exactly 20 mcg once daily at approximately the same time each day. 2
- Never inject more than one dose in the same day, even if a dose is missed. 1
- For the first few doses, inject in a location where the patient can immediately sit or lie down if orthostatic symptoms occur. 1
Special Monitoring Considerations
- Patients with hypertension or taking antihypertensive medications require particularly careful monitoring for hypotension during the first hour after injection. 6
- Patients should wait at least 1 hour after injection before engaging in activities requiring alertness if they experience dizziness. 6
Common Side Effects Counseling
- Inform patients that the most common side effects include pain at injection site, nausea, and joint aches. 1
- Dizziness (10.3%), nausea (10.3%), back pain (7.8%), and muscle cramps (7.8%) are frequently reported but typically mild. 7
- Most injection-related concerns (discomfort, anxiety about daily injections) substantially decrease within the first 6 months of treatment. 7