Names and pronunciation
(tah-ree-par′ah-tide) Forteo
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Drug reference
(tah-ree-par′ah-tide) Forteo
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Func. class.: Parathyroid hormone (rDNA)
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Chem. class.: Teriparatide
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ACTION: Contains human recombi- nant parathyroid hormone to stimulate new bone growth
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USES: Postmenopausal women with osteoporosis, men with primary or hypogonadal osteoporosis who are at high risk for fracture, glucocorticoid- induced osteoporosis
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Unlabeled uses: Hypoparathyroidism
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CONTRAINDICATIONS: Hyper- sensitivity, increased baseline risk for osteosarcoma (Paget’s disease, open epiphyses; previous bone radiation), bone metastases, history of skeletal malignancies, other metabolic bone diseases, preexisting hypercalcemia Precautions: Pregnancy, breastfeeding, children, urolithiasis, hypotension, use >2 yr, cardiac disease
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Black Box Warning: Secondary malig- nancy (osteogenic sarcoma) Black Box Warning: Secondary ma- lignancy: osteosarcoma, dependent on length of treatment; those at higher risk for osteosarcoma should not use this product, monitor for bone pain, fracture risk • Labs: Uric acid, magnesium, creati- nine, BUN, urine pH, vit D, phosphate for normal serum levels; serum calcium may be transiently increased after dosing (max at 4-6 hr after dose) • Adverse reactions: Bone pain, head- ache, fatigue, changes in LOC, leg cramps • Signs of persistent hypercalcemia: nausea, vomiting, constipation, lethargy, muscle weakness • Nutritional status: diet for sources of vit D (milk, some seafood), calcium (dairy products, dark green vegetables), phosphates (dairy products) • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; not to be used in pregnant females; do not breastfeed
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SIDE EFFECTS CNS: Dizziness, headache, insomnia, depression, vertigo CV: Hypertension, angina, syncope GI: Nausea, diarrhea, dyspepsia, vomit- ing, constipation INTEG: Rash, sweating MISC: Pain, asthenia, hyperuricemia MS: Arthralgia, leg cramps, back/leg pain, weakness, osteosarcoma (rare) RESP: Rhinitis, cough, pharyngitis, pneumonia, dyspnea
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INTERACTIONS Increase: digoxin toxicity: digoxin Drug/Lab Test Increase: calcium, uric acid, urinary calcium Decrease: phosphorous, magnesium
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DOSAGE AND ROUTES • Adult: SUBCUT 20 mcg/day up to 2 yr
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Available forms: Prefilled pen delivery device (delivers 20 mcg/day)
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Administer: SUBCUT route • Solution should be clear/colorless • Give by SUBCUT using disposable pen only; inject in thigh or abdomen; lightly pinch fold of skin; insert needle; release skin; inject at 90-degree angle over 5 sec; rotate inj sites • Have patient sit or lie down; ortho- static hypotension may occur • Protect from freezing, light; refrigerate pen • Store refrigerated; do not freeze; may be used for 28 days after first inj
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Assess:
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Evaluate: • Therapeutic response: increased bone mineral density
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the symptoms of hypercalcemia • About foods rich in calcium, vit D • How to use delivery device, dispose of needles; not to share pen with others; to use at same time of day • To sit or lie down if dizziness or fast heartbeat occurs after 1st few doses • To report persistent bone pain, severe fatigue, weight loss, falls, swelling • To rotate administration sites • To store pen in refrigerator; pen may be used for 28 days
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PHARMACOKINETICS SUBCUT: Extensively and rapidly absorbed, metabolized by liver, excreted by kidneys, terminal half-life 1 hr, onset rapid, peak 1⁄2 hr, duration 3 hr
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• Adult: SUBCUT 20 mcg/day up to 2 yr
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