Side Effects of Teriparatide

Generally, teriparatide is well tolerated.

The most common side effects, among others, are dizziness, nausea, heartburn, diarrhea, headache and leg cramps, pain, weakness, and depression. Lowered blood pressure (hypotension) when standing can occur with the first few doses but does go away in a matter of hours. Patients may be told to lie down after the injection. There have been some cases of slightly elevated serum calcium, and elevated calcium in the urine (which can lead to kidney stones). Ooccasionally transient hypercalcemia occurs 4 to 6 hours after injection, reducing blood serum calcium concentrations.

If any of these side effects persist or worsen, the prescribing doctor should be informed. More serious reactions have included chest pain, fainting, difficulty breathing, more severe nausea, vomiting, constipation, and muscle weakness. Allergic reactions can occur, from itching at the injection site to more serious symptoms of allergy including swelling, and difficulty breathing. Serious side effects warrant immediate medical attention.

When teriparatide was given to growing young rats, they developed osteogenic sarcoma, a very malignant tumor. The drug should not be given to anyone at risk for developing this bony cancer. That would include patients with Paget’s disease, those with elevated alkaline phosphatase (which could indicate a problem in bone), patients who had radiation therapy to their bones, or children and young adults whose bones are still growing.
At this time, the recommended length of treatment is two years. There are many ongoing clinical trials to determine the best way to use teriparatide, with other medicines like alendronate, how long treatment should last, and which patients with osteoporosis will benefit the most from it. There have been attempts to deliver the medication as a nasal spray instead of injection. It is also being tested for other conditions. One, called osteogenesis imperfecta is a genetic bone disease causing brittle bones. Teriparatide is being tried as a treatment for adults with osteogenesis imperfecta. It is also being tested as an aid to fracture healing. There are some 50 trials in various stages at this time, and new uses for teriparatide will probably be found.

The approved dose (20Fg daily by subcutaneous injection) and duration of treatment have not been found to be associated with an increased risk of osteosarcoma in humans.

The AFP's guidelines, based on a systematic evidence review of previously published studies.