Teriparatide

Pronunciation: ter i PAR a tide
Brand name: Forteo
Dosage form: injection pen
Drug class: Parathyroid hormone and analogs

Medically reviewed by Melisa Puckey, BPharm. Last updated on Jun 6, 2025.

What is teriparatide?

Teriparatide injection is a prescription medicine used to treat osteoporosis in specific men and postmenopausal women who are at high risk for bone fractures and are unable to use other treatments for osteoporosis. Teriparatide injections help to stimulate the natural bone-rebuilding process to increase bone mineral density and bone strength, which may prevent fractures. 

Teriparatide is a man-made form of parathyroid hormone that exists naturally in the body and is involved in bone remodeling. Teriparatide injection works (mechanism of action) by acting on specific receptors (PTH1 receptor). This increases the activity and number of osteoblasts (cells that lay down new bone), which increases bone mass (bone mineral density). 

Teriparatide injection is given once a day under the skin (subcutaneous injection) in your thigh or abdomen, using a prefilled pen. Forteo is available as an easy-to-use delivery device that can be self-administered. Each pen contains 28 doses. 

Teriparatide brand name Forteo.

Who can use teriparatide injection?

Teriparatide FDA approval is for the treatment of: 

• Postmenopausal women who have osteoporosis, who are at high risk for having broken bones (fractures), or who cannot use other treatments for osteoporosis. Forteo helps to decrease the chance of broken bones in the spine and other bones in postmenopausal women who have osteoporosis. 
• Men with primary or hypogonadal osteoporosis who are at high risk for having broken bones, or who cannot use other treatments for osteoporosis. Forteo helps to increase the bone mass in men with primary or hypogonadal osteoporosis.
• Men and women with osteoporosis due to the use of glucocorticoid medicines, such as prednisone, for several months, who are at high risk for having broken bones (fractures) or who cannot use other osteoporosis treatments.

Patients should take calcium and vitamin D supplements if their dietary intake is inadequate.

Using teriparatide for more than 2 years during a patient's lifetime should only be considered if a patient remains at or has returned to having a high risk for fracture.

Teriparatide side effects

Common teriparatide side effects

The most common teriparatide side effects may include:

• Pain 21.3%
• Joint pain 10.1%
• Runny nose  9.6%
• High blood pressure 8.7%
• Nausea 8.5%
• Dizziness 8.0%
• Headache 7.5%
• Weakness tiredness or lack of energy 7.1%
• Increased cough 6.4%
• Pharyngitis 5.5%
• Constipation 5.4%
• Indigestion 5.2%
• Diarrhea 5.1%

These common side effects occurred in 5% or more of men and women using Forteo in the two principal osteoporosis trials.

Serious teriparatide side effects

Get emergency medical help if you have signs of an allergic reaction to teriparatide including hives; difficulty breathing, and swelling of your face, lips, tongue, or throat.

Other serious side effects can occur, call your doctor at once if you have:

• bone pain;
• new or unusual swelling or lumps under your skin;
• a light-headed feeling, like you might pass out (may occur within 4 hours after injection);
• pounding heartbeats or fluttering in your chest after using an injection; or
• high calcium levels - confusion, muscle weakness, nausea, vomiting, lack of energy, constipation, increased thirst or urination, weight loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Related/similar drugs

Before taking this medicine

You should not use teriparatide injection if you are allergic to the active ingredient teriparatide or any of the inactive ingredients.

Teriparatide injection is not for use in children or young adults whose bones are still growing.

To make sure teriparatide injection is safe for you, tell your doctor if you have ever had:

• Paget's disease or a bone disease other than osteoporosis;
• bone cancer or radiation treatment;
• a genetic condition that increases your risk of bone cancer;
• overactive parathyroid glands;
• high blood levels of calcium;
• a painful skin condition caused by too much calcium;
• kidney failure;
• a kidney stone; or
• an autoimmune disorder such as rheumatoid arthritis, lupus, or psoriasis.

Pregnancy 

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Breastfeeding

It is not known whether teriparatide passes into breast milk or if it could harm a nursing baby. You should not breastfeed while using this medicine.

Warnings

Teriparatide injection has caused bone cancer (osteosarcoma) in animals, but it is not known whether this would occur in people using this medicine. Talk with your doctor about your own risk.

Tell your doctor if you have conditions such as Paget's disease, high blood levels of calcium or alkaline phosphatase, or a history of bone cancer or radiation treatment involving your bones.

Avoid smoking cigarettes or drinking alcohol. Smoking or heavy drinking can reduce your bone mineral density, making fractures more likely.

How should I use teriparatide?

Teriparatide is injected under the skin with an easy-to-use pen. A healthcare provider should teach you how to properly use the medication by yourself.

Teriparatide injection is usually given once per day at the same time each day.

Teriparatide comes in a prefilled pen device to make the daily injection easier.

The pen injector contains enough medicine for 28 doses. Throw away the pen after 28 days of use, even if it isn't empty.

Use teriparatide injection exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Teriparatide injection instructions

Remove the teriparatide from the refrigerator

Pull of white cap

Attach a new needle 

• Pull off the paper tab.
• Push the needle straight onto the medicine cartridge and screw the needle on in a clockwise motion.
• Pull off the large needle cover and put the cover aside.

Set dose

• Pull out the black injection button until it stops.
• Check to make sure you can see the red stripe.
• Remove the small needle protector and discard.

Inject dose

• Gently pinch a fold of skin on your abdomen or thigh and insert the needle straight into the skin at a 90-degree angle.
• Use a different place each time you give an injection. Do not inject into the same place two times in a row.
• Push the black button in until it stops.
• Hold the device in place and count to 5 slowly to ensure you receive the correct dose.
• Remove the device from your skin.

Check dose

• Once you complete your injection and remove the needle from your skin take your thumb off the black injection button.
• Check to make sure the black button is completely in.
• You should not see the yellow shaft if it has been administered correctly.

Remove needle

• Replace the needle cover as instructed.
• Unscrew the covered needle by turning it counter-clockwise.
• Remove the needle and discard it into a sharps container.
• Push the white cap back on.

Storage

• Return the teriparatide to the refrigerator for storage.

General administration information

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you don't understand all the instructions.

Prepare the teriparatide injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.

Use only the injection pen provided with teriparatide. Do not transfer the medicine to a syringe or other injection device or you could get an overdose.

Teriparatide can cause you to feel dizzy or light-headed. Always give your injection at a time and place where you can sit or lie down for a short time afterward.

Each prefilled injection pen contains enough teriparatide for 28 separate injections. 

Throw the pen away after 28 injections, even if there is still medicine left inside.

Teriparatide may be only part of a complete treatment program that also includes diet, exercise, taking vitamin or mineral supplements, and changing certain behaviors. Follow your doctor's instructions very closely.

Store the teriparatide injection pen in a refrigerator when not in use. Take the pen out of the refrigerator only long enough to use it. After use, remove the needle, recap the pen, and return it to the refrigerator.

Do not freeze teriparatide, and throw away the medicine if it has become frozen.

Teriparatide dosing information

Usual adult teriparatide dose for osteoporosis:

• 20 mcg subcutaneously once a day into the thigh or abdominal wall
• Duration of Therapy: Lifetime use greater than 2 years should only be considered if fracture risk remains high.
• Supplemental calcium and vitamin D should be taken if daily dietary intake is inadequate.

What happens if I miss a dose?

Use the missed dose on the same day you remember it. Use your next dose at the regular time and stay on your once-daily schedule. Do not use 2 doses in one day.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, dizziness, headache, feeling light-headed, or fainting.

What should I avoid while using teriparatide?

Avoid driving or hazardous activities until you know how this medicine will affect you. Your reactions could be impaired.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid smoking, or try to quit. Smoking can reduce your bone mineral density, making fractures more likely.

Avoid drinking large amounts of alcohol. Heavy drinking can also cause bone loss.

What other drugs will affect teriparatide?

Tell your doctor about all your other medicines, especially:

• digoxin, digitalis.
• warfarin (Coumadin, Jantoven); or
• a steroid medicine (such as hydrocortisone, prednisone, methylprednisolone, and others).

This list is not complete. Other drugs may interact with teriparatide, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Forteo Package Insert 

HCPs and patients often use the Forteo Package Insert (PI) for more detailed information about this medicine. The  Package Insert (prescribing information) contains more comprehensive information on Indications and Usage, Dosage and Administration, Clinical Pharmacology, Clinical Studies, Drug Interaction, and more. Discuss any medical questions you have with your HCP (health care professional). This is not all the information you need to know about this medicine for safe and effective use, and it does not take the place of talking to your doctor about your treatment.

The Package Insert is sometimes called the Forteo Prescribing Information (PI) or FDA label.

Storage

• Store in the refrigerator between 36°F to 46°F (2°C to 8°C) until ready to use.
• Use it right away after you remove it from the refrigerator.
• Do not freeze Forteo. If it has been frozen, do not use it.
• Always throw away the Forteo pen 28 days after your first use, even if there is still medicine left inside.
• Do not use the injection after the expiration date printed on the delivery device and packaging.
• Recap Forteo and place in the refrigerator when not in use to protect it from heat, physical damage, and light.

Ingredients

Forteo active ingredient: teriparatide

Forteo Inactive ingredients: glacial acetic acid, sodium acetate (anhydrous), mannitol, metacresol, and water for injection. In addition, hydrochloric acid solution 10% and/or sodium hydroxide solution 10% may have been added to adjust the product to pH 4.

Company

Forteo Lilly USA, LLC, Indianapolis, IN 46285, USA

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Further information

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