Teriparatide

Occurs in up to 30% of users. Usually resolves within hours to days. Minimize by allowing solution to reach room temperature, rotating sites, and using proper injection technique. Apply ice if needed.

Serum calcium rises 1-2 hours post-injection and normalizes within 4-6 hours. More pronounced in patients with high baseline calcium or vitamin D levels. Monitor serum calcium at baseline and periodically during treatment.

Reported in 8-13% of users, typically mild and transient. Usually occurs within 30 minutes of injection and resolves within 1-2 hours. May be reduced by injecting in the evening or with food.

Occurs in 5-7% of users, particularly within 30 minutes of injection. Sit or lie down during injection if prone to dizziness. Usually resolves quickly.

Reported in 5-6% of users. Generally mild and self-resolving. May be related to transient hypercalcemia.

Reported in 3-5% of users. May be related to electrolyte shifts or increased bone turnover. Ensure adequate hydration and electrolyte intake.

Teriparatide increases serum uric acid due to increased bone turnover. Patients with history of gout should be monitored. Urate-lowering therapy may be needed.

Increased urinary calcium excretion may occur. Patients with history of nephrolithiasis should maintain adequate hydration and may require monitoring of 24-hour urinary calcium.

Osteosarcoma was observed in rats receiving high-dose teriparatide for 2 years. No cases have been confirmed in humans during clinical trials or post-marketing surveillance. FDA recommends limiting treatment to 24 months and avoiding use in patients with open epiphyses, prior radiation therapy, or elevated baseline alkaline phosphatase.

Serum phosphate may rise transiently post-injection. Normalizes within 4-6 hours. Clinically insignificant in most patients with normal renal function.

Hypersensitivity reactions including rash, urticaria, or anaphylaxis are extremely rare. Discontinue immediately and seek medical attention if symptoms occur.