Meta Information
ID:teriparatide
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Teriparatide can cause a temporary increase in blood calcium levels, which significantly enhances the effects of digoxin and can lead to serious, life-threatening heart rhythm problems (digoxin toxicity).
Actionable advice:
This should not be used with digoxin; if unavoidable, it requires extremely close monitoring of calcium levels and heart function by a physician.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
5.5 Risk of Digoxin Toxicity Hypercalcemia may predispose patients to digitalis toxicity because Teriparatide injection transiently increases serum calcium.
Label source:
Action type:
avoid
Target id:
/condition/hypercalcemia
Target name:
Hypercalcemia (High Blood Calcium)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Teriparatide's primary mechanism involves increasing serum calcium levels, making it strictly contraindicated in individuals who already have high blood calcium.
Actionable advice:
This medication should not be used with pre-existing hypercalcemia.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
5.5 Risk of Digoxin Toxicity Hypercalcemia may predispose patients to digitalis toxicity because Teriparatide injection transiently increases serum calcium.
Label source:
Action type:
avoid
Target id:
/procedure/long-term-use-over-24-months
Target name:
Cumulative Use Beyond 24 Months
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Due to a theoretical risk of osteosarcoma observed in animal studies, the cumulative lifetime use of teriparatide and related drugs is limited to a maximum of 24 months.
Actionable advice:
Teriparatide should not be used for more than a total of 2 years over an entire lifetime.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, and Impairment of Fertility Long-term animal studies to address the carcinogenic potential of palopegteriparatide have not been conducted.
Label source:
Action type:
avoid
Target id:
/condition/bone-malignancy-risk
Target name:
Increased Risk for Osteosarcoma
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Teriparatide is contraindicated in conditions with an increased baseline risk of osteosarcoma, such as Paget's disease of bone, prior skeletal radiation, bone metastases, or unexplained high alkaline phosphatase.
Actionable advice:
This should not be used with Paget's disease, bone cancer, or prior radiation therapy to the bones.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Potential Risk of Osteosarcoma: YORVIPATH is not recommended
in patients at increased risk of osteosarcoma.
Label source:
FDA label: Palopegteriparatide (Yorvipath)
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The effects of teriparatide on a developing fetus are unknown and potential risks cannot be ruled out.
Actionable advice:
This should be strictly avoided during pregnancy.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
When pregnant rats received teriparatide during organogenesis at subcutaneous doses 16 to 540 times the human dose, the fetuses showed no abnormal findings.
Label source:
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is not known if teriparatide passes into breast milk, so its use is contraindicated to avoid potential harm to the infant.
Actionable advice:
It should be avoided completely while breastfeeding.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
8.2 Lactation Risk Summary It is not known whether teriparatide is excreted in human milk, affects human milk production, or has effects on the breastfed infant.
Label source:
Action type:
avoid
Target id:
/intervention/calcium-supplements
Target name:
Calcium Supplements
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Teriparatide builds new bone, a process that requires adequate calcium as a fundamental building block to be effective.
Actionable advice:
Adequate daily calcium intake (typically 1200 mg total from diet and supplements) should be maintained, as recommended by a doctor.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In these women, calcium supplements and/or Teriparatide injection doses were reduced.
Label source:
Action type:
informational_none
Target id:
/intervention/vitamin-d
Target name:
Vitamin D
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Vitamin D is necessary for the body to absorb calcium from the gut; sufficient levels are required for teriparatide to effectively build new bone.
Actionable advice:
Adequate daily Vitamin D intake should be maintained to keep sufficient blood levels, as recommended by a doctor.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
albumin-corrected serum calcium of at least 7.8 mg/dL using
calcium and active vitamin D treatment.
Label source:
FDA label: Palopegteriparatide (Yorvipath)
Action type:
informational_none
Target id:
/biomarker/serum-calcium
Target name:
Serum Calcium Test
Severity:
major
Interaction type:
assay_interference
Nature:
temporal
Temporal spacing:
Hours before target:
16
Hours after target:
null
Description:
Teriparatide causes a temporary rise in blood calcium, peaking 4-6 hours after injection. Measuring calcium too soon after a dose will give a falsely elevated result not reflective of your baseline.
Actionable advice:
Schedule blood draws for serum calcium at least 16 hours after your last teriparatide injection.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The median peak serum calcium concentration measured 4 to 6 hours after dosing with Teriparatide injection was 9.44 mg/dL at 12 months.
Label source:
Action type:
separate
Target id:
/class/thiazide-diuretics
Target name:
Thiazide Diuretics
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Thiazide diuretics reduce the amount of calcium excreted by the kidneys. When combined with teriparatide's calcium-increasing effect, this can lead to hypercalcemia.
Actionable advice:
This is best used with caution, and it is a good idea to have a doctor monitoring blood calcium levels closely.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The effect of coadministration of a higher dose of hydrochlorothiazide with Teriparatide injection on serum calcium levels has not been studied.
Label source:
Action type:
monitor
Target id:
/intervention/bisphosphonates
Target name:
Bisphosphonates
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Concurrent use is generally not recommended as bisphosphonates (which prevent bone breakdown) may blunt the bone-building (anabolic) effect of teriparatide.
Actionable advice:
Concurrent use is best avoided; these therapies are typically used sequentially, not together.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In a clinical study of women previously treated for 18 to 39 months with raloxifene (n=26) or alendronate (n=33), mean serum calcium >12 hours after Teriparatide injection treatment was increased by 0.36 to 0.56 mg/dL, after 1 to 6 months of Teriparatide injection treatment compared with baseline.
Label source:
Action type:
avoid
Target id:
/intervention/denosumab
Target name:
Denosumab (Prolia)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Concurrent use is not recommended as denosumab (an anti-resorptive agent) may interfere with the primary bone-building mechanism of teriparatide.
Actionable advice:
Concurrent use is best avoided; these therapies are typically used sequentially, not together.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
are allergic to denosumab or any of the ingredients in Prolia.
Label source:
Action type:
avoid
Target id:
/condition/renal-impairment
Target name:
Moderate to Severe Renal Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
In patients with poor kidney function, teriparatide is cleared more slowly and may lead to more significant and prolonged increases in blood calcium.
Actionable advice:
This is best used with caution in moderate kidney disease, and is best avoided in severe kidney disease.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Furosemide - In a study of 9 healthy people and 17 patients with CrCl 13 to 72 mL/minute, coadministration of intravenous furosemide (20 to 100 mg) with Teriparatide injection 40 mcg (2 times the recommended dose) resulted in small increases in the serum calcium (2%) and 24-hour urine calcium (37%); however, these changes did not appear to be clinically important.
Label source:
Action type:
avoid
Target id:
/procedure/standing-up-quickly
Target name:
Standing Up Quickly
Severity:
moderate
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
null
Hours after target:
4
Description:
Teriparatide can cause a temporary drop in blood pressure upon standing (orthostatic hypotension), especially within the first few hours after the initial doses.
Actionable advice:
For the first few doses, it is a good idea to inject where sitting or lying down is possible, and to rise slowly for 4 hours after injection.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Orthostatic Hypotension: Has been reported with YORVIPATH.
Monitor for signs and symptoms of orthostatic hypotension.
Label source:
FDA label: Palopegteriparatide (Yorvipath)
Action type:
separate
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Teriparatide can cause a temporary drop in blood pressure upon standing, an effect that may be additive with other blood pressure-lowering drugs.
Actionable advice:
Some caution when standing up may help for the first few hours after injection, especially when also taking blood pressure medication.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Decrease in blood pressure when you change positions.
Label source:
Action type:
separate
Target id:
/condition/gout
Target name:
Gout or High Uric Acid Levels
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Teriparatide can cause transient increases in serum uric acid, which may precipitate or worsen gout attacks in susceptible individuals.
Actionable advice:
This is best used with caution in those with a history of gout, and it is worth monitoring for symptoms of a flare-up.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
However, the hyperuricemia did not result in an increase in gout, arthralgia, or urolithiasis.
Label source:
Action type:
monitor
Target id:
/intervention/raloxifene
Target name:
Raloxifene
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Co-administration of raloxifene and teriparatide has not shown additional benefit on bone density and was associated with small increases in serum calcium and uric acid.
Actionable advice:
Concurrent use is generally not recommended as it offers no extra benefit and may slightly increase side effects.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In a clinical study of women previously treated for 18 to 39 months with raloxifene (n=26) or alendronate (n=33), mean serum calcium >12 hours after Teriparatide injection treatment was increased by 0.36 to 0.56 mg/dL, after 1 to 6 months of Teriparatide injection treatment compared with baseline.
Label source:
Action type:
avoid
Target id:
/biomarker/alkaline-phosphatase
Target name:
Alkaline Phosphatase (ALP)
Severity:
minor
Interaction type:
assay_interference
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Teriparatide stimulates bone formation, which is expected to increase levels of bone-specific alkaline phosphatase. This is a sign of therapeutic effect, not pathology.
Actionable advice:
Elevated ALP is an expected finding during therapy and reflects bone-building activity.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Effects on Markers of Bone Turnover - Daily administration of Teriparatide injection to men and postmenopausal women with osteoporosis in clinical studies stimulated bone formation, as shown by increases in the formation markers serum bone-specific alkaline phosphatase (BSAP) and procollagen I carboxy-terminal propeptide (PICP).
Label source:
Action type:
monitor