Palopegteriparatide

How it works

It is a sustained-release form of teriparatide (a PTH analogue) that provides continuous parathyroid hormone receptor activity, regulating calcium and phosphate homeostasis and reducing reliance on calcium and active vitamin D supplements.

Prescribing in practice

• Calcium levels must be closely monitored when starting and adjusting therapy, as changes can cause hypercalcaemia or hypocalcaemia, with active vitamin D and calcium supplements titrated accordingly.
• It is given by once-daily subcutaneous injection as replacement, distinct from intermittent PTH analogues used for osteoporosis.
• Conventional calcium and active vitamin D therapy is typically reduced as PTH replacement takes effect, guided by serum calcium.

Monitoring

Monitor serum calcium (and phosphate and vitamin D) regularly, especially during initiation and dose adjustment, with supplements titrated to maintain calcium in the target range.

Counselling the patient

• Inject once daily as instructed and attend regular blood tests for calcium.
• Your calcium and vitamin D supplements will likely be adjusted as treatment is established.
• Report symptoms of high or low calcium such as tingling, cramps, nausea or excessive thirst.

Evidence & guidelines

Palopegteriparatide is approved as PTH replacement for chronic hypoparathyroidism on the basis of trials showing maintenance of normal calcium with reduced conventional therapy.