Teriparatide

Molecular formula Cisi H291N55O51 Sj Molecular weight 4117.72 

Mobile phase Gradient. MeCN 0.1% trifluoroacetic acid from 20 80 to 60 40 over 40 min. Detector UV (wavelength not specified) 

Oldenburg, K.R. D Orfani, A.L. SeUck, H.E. A method for the high-level expression of a parathyroid hormone analog in Escherichia coli, Protein Expr.Purif, 1994, 5, 278-284. 

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Teriparatide 250 mcg/mL, 20 meg SQ daily Inject into thigh or abdominal 590 per... 

Teriparatide, recombinant human parathyroid hormone) 1-34), is the first anabolic agent approved by the FDA for treatment of... 

The combination of a bisphosphonate with anabolic therapy (teriparatide) should not be used because a well-controlled trial showed that women receiving the combination actually had smaller increases in bone mineral density than women receiving teriparatide alone.44 However, sequential therapy with these agents may be more promising. In one study, women who received alendronate for 1 year directly after receiving parathyroid hormone for 1 year had greater... 

Compared with postmenopausal osteoporosis, few clinical trials have been conducted evaluating therapies in men. Although alendronate and calcitonin have both been studied, only alendronate reduces fracture rates in men. Teriparatide also has been studied, but no data are available yet on fracture rates. At this time, alendronate and teriparatide are approved by the FDA for the treatment of osteoporosis in men. Owing to proven benefit in reducing fractures and relative safety, alendronate should be considered first-line treatment for primary osteoporosis in men. Teriparatide should be reserved as alternate therapy in this population. 

Teriparatide can be considered a first-line option in patients with a T-score <-3.5. 

Calcitonin (Miacalcin) Teriparatide (1-34 units, Forteo) 200 units intranasal daily, alternating nares every other day 20 meg subcutaneously daily for up to 2 years... 

Teriparatide is a recombinant product representing the first 34 amino acids in human parathyroid hormone. Teriparatide increases bone formation, the bone remodeling rate, and osteoblast number and activity. Both bone mass and architecture are improved. 

Teriparatide is FDA approved for postmenopausal women and men who are at high risk for fracture. Candidates for therapy include patients with a history of osteoporotic fracture, multiple risk factors for fracture, very low bone density (e.g., T-score <—3.5), or those who have failed or are intolerant of previous bisphosphonate therapy. 

Discontinuation of therapy results in a decrease in BMD, but some antifracture efficacy appears to be maintained. Sequential therapy with teriparatide followed by an antiresorptive agent (e.g., bisphosphonate) should be considered to maintain BMD gains. 

Teriparatide is contraindicated in patients at baseline increased risk for osteosarcoma (e.g., Paget s bone disease, unexplained alkaline phosphatase elevations, pediatric patients, young adults with open epiphyses, or patients with prior radiation therapy involving the skeleton). 

Teriparatide can be used if bisphosphonates are not tolerated or contraindicated. Testosterone replacement therapy should be considered in men, and high-dose hormonal oral contraceptives can be considered for premenopausal women with documented hypogonadism. 

Deal C, Omizo M, Schwartz EN, Eriksen EF, Cantor P, Wang J, et al. (2004) Raloxifene in combination with teriparatide reduces teriparatide-induced stimulation of bone resorption but not formation in postmenopausal women with osteoporosis. J Bone Min Res 19(Suppl 1) 1169... 

Ettinger B, San Martin J, Crans G, Pavo I (2004) Differential effects of teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res 19 745-751... 

Finally, in very severe cases, the alternative to a bone remodeling agent such as teriparatide should be taken into consideration. The place for strontium ranelate, a substance without age-related contraindications, remains to be established as clinical experience in its use grows. 

Teriparatide (Forteo) Zoledronic acid (Zometa, Reclast)... 

Teriparatide (Forteo) [Antiosteoporotic/Parathyroid Hormono] WARNING T Osteosarcoma risk in animals, therefore only use in pts for whom the potential benefits outweigh risks Uses Severe/refractory osteoporosis Action PTH (recombinant) Dose 20 meg SQ daily in thigh or abd Caution [C, /-] Contra w/ Paget Dz, prior radiation, bone metastases, T Ca caution in urolithiasis Disp Inj SE Orthostatic X BP on administration, N/D, T... 

Teriparatide is a recombinant form of parathyroid hormone, used in the treatment of advanced osteoporosis. 

Contraindications Serum calcium above normal level, those at increased risk for osteosarcoma (Paget s disease, unexplained elevations of alkaline phosphatase, open epiphyses, prior radiation therapy that included the skeleton), hypercalcemic disorder (e.g., hyperparathyroidism), hypersensitivity to teriparatide or any of the components of the formulation... 

Inform patients teriparatide caused osteosarcoma in rats clinical relevance in humans unknown... 

Teriparatide, the recombinant form of PTH 1-34, is approved for treatment of osteoporosis. Teriparatide is given in a dosage of 20 meg subcutaneously daily. Like fluoride, teriparatide stimulates new bone formation, but unlike fluoride, this new bone appears structurally normal and is associated with a substantial reduction in the incidence of fractures. Teriparatide is approved for use for only 2 years. Trials examining the sequential use of teriparatide followed by a bisphosphonate after 1 or 2 years are in progress and look promising. Giving teriparatide with a bisphosphonate has not shown greater efficacy than the bisphosphonate alone. 

Calcitonin is approved for use in the treatment of postmenopausal osteoporosis. It has been shown to increase bone mass and reduce fractures, but only in the spine. It does not appear to be as effective as bisphosphonates or teriparatide. 

Teriparatide These hormones act on their cognate receptors coupled to G protein signaling pathways Teriparatide stimulates bone turnover, calcitonin suppresses bone resorption Both are used in osteoporosis calcitonin is used for hypercalcemia Teriparatide may cause hypercalcemia and hypercalciuria... 

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