Teriparatide 750 mcg vial dosage

What Teriparatide is

Class:

Recombinant human parathyroid hormone (1-34), a peptide

Also called:

Forteo, Bonsity

Used for:

FDA-approved to treat osteoporosis in postmenopausal women and men at high fracture risk, and glucocorticoid-induced osteoporosis in men and women at high fracture risk, by stimulating new bone formation.

Human evidence:

Strong human evidence. The pivotal randomised, placebo-controlled Fracture Prevention Trial in postmenopausal women with prior vertebral fracture found teriparatide reduced new vertebral and nonvertebral fractures and raised bone mineral density at the doses that led to FDA approval. FDA required a boxed warning over osteosarcoma seen in rats given high, prolonged doses; two real-world claims-linkage studies of human teriparatide use found no increase in osteosarcoma, and FDA removed the boxed warning in November 2020 and relaxed the 2-year lifetime limit (use beyond 2 years is now to be considered only if fracture risk remains or returns to high), while keeping a narrower warnings-section caution because the human evidence base for long-term or repeated use is still limited.

Half-life:

About 1 hour, per the FDA label.

US status:

FDA-approved · prescription only. FDA-approved as Forteo since 2002, with generic teriparatide products also approved; requires a prescription. Approved in Australia and on the ARTG as a prescription-only (Schedule 4) medicine.

The full picture, with every study: Teriparatide guide.

How to mix a 750 mcg Teriparatide vial

For this vial: 2 mL of bacteriostatic water makes 0.38 mg/mL, so 20 mcg is 5.5 units (0.05 mL) on a U-100 insulin syringe. Pick a different volume from the units table if you want bigger or smaller draws; the number of doses stays the same.

1. Wipe the rubber stoppers of both the peptide vial and the bacteriostatic water vial with an alcohol swab and let the alcohol dry. ^[2][3]
2. With a new sterile needle and syringe, draw up the amount of bacteriostatic water you have chosen for the dilution. ^[2][3][4]
3. Inject the water into the peptide vial by aiming the stream against the inside glass wall, which helps prevent foaming. ^[5]
4. Swirl or roll the vial gently until the powder has fully dissolved; do not shake it. Do not inject the solution if it is cloudy or has particles in it. ^[2][3][5]
5. Label the vial with the date and time it was mixed, the amount of water added and how long it can be used after mixing. ^[2]
6. Store the mixed vial in the refrigerator at 2-8°C (36-46°F) and do not freeze it. ^[5]

Step by step with pictures: how to reconstitute peptides. About the water itself: bacteriostatic water.

Storing Teriparatide vials

• Freeze-dried (lyophilized) peptide keeps far longer than peptide in solution; peptide suppliers advise storing the powder at -20°C away from bright light. ^[6]
• Protect peptide vials from heat and light. ^[6][7]
• Avoid repeated freeze-thaw cycles; a prescription peptide label also says not to freeze a vial once it has been mixed. ^[5][6]
• Once a multi-dose vial, such as bacteriostatic water, has been opened (needle-punctured), date it and discard it within 28 days unless its manufacturer states another date. ^[8][9]

More detail: peptide storage and shelf life.

Injecting safely

• Clean the injection site with an alcohol swab and let the skin dry completely before injecting. ^[10][11]
• Pinch up a fold of skin and fat (not muscle) and insert the needle at a 45- to 90-degree angle: 90 degrees where there is enough fatty tissue, 45 degrees where there is little. ^[10][11][12]
• Pulling back on the plunger (aspiration) is not necessary for a subcutaneous injection, because the chance of the needle being in a blood vessel is small. ^[10]
• Inject slowly, at roughly 10 seconds per mL. ^[10]
• Common sites are the belly, the thigh and the upper arm; rotate sites, keeping each injection at least 1 inch (2.5 cm) from the last. ^[5][10][11]

Hygiene and warning signs

• Use a new sterile needle and syringe for every injection and every time you enter a vial; never reuse them. ^[4][8][11]
• Never share needles, syringes or pens with anyone, even if the needle is changed; unsafe injection practices spread hepatitis B, hepatitis C and HIV. ^[4][7][8]
• Put used needles and syringes in a sharps disposal container straight away (FDA-cleared if possible), never loose in the trash, recycling or toilet, and dispose of the container following your community's guidelines. ^[13][14]
• Contact a health care provider if the injection site shows signs of infection, such as redness, swelling, red streaks or a fever. ^[11]

Where to inject: subcutaneous injection sites.

How Teriparatide works

• Teriparatide is a recombinant form of parathyroid hormone (PTH) 1-34. Its sequence matches the first 34 amino acids of the body's 84-amino-acid hormone, the part that carries its biological activity, and it binds the same receptors with the same affinity. ^[1]
• Given once a day, it builds new bone on both inner (trabecular) and outer (cortical) bone surfaces by stimulating bone-forming osteoblasts more than bone-resorbing osteoclasts. Continuously high PTH, as in hyperparathyroidism, has the opposite effect and can favour bone loss. ^[1]
• Each dose briefly raises blood calcium. The rise starts about 2 hours after injection, peaks at 4 to 6 hours and returns to baseline by 16 to 24 hours. ^[1]

What the Teriparatide research found

Human evidence: strong human evidence. Each result says what was studied.

• Human studyIn the pivotal randomised trial of 1,637 postmenopausal women with prior vertebral fractures (median 21 months), new vertebral fractures occurred in 14% on placebo against 5% on 20 micrograms and 4% on 40 micrograms daily. New non-vertebral fragility fractures fell from 6% to 3%. ^[15]
• Human studyIn the same trial, the 20-microgram dose raised lumbar spine bone density by 9 more percentage points than placebo, and femoral neck density by 3 more. ^[15]
• Human studyIn the VERO trial of 1,360 postmenopausal women with severe osteoporosis, new vertebral fractures over 24 months occurred in 5.4% on teriparatide against 12.0% on the oral bisphosphonate risedronate. Non-vertebral fractures (4.0% vs 6.1%) did not differ significantly. ^[16]
• Human studyIn an 18-month trial of 428 people with glucocorticoid-induced osteoporosis, lumbar spine bone density rose 7.2% on teriparatide against 3.4% on alendronate, with fewer new vertebral fractures (0.6% vs 6.1%). Non-vertebral fractures were similar. ^[17]
• FDA labelIn a placebo-controlled trial of 437 men with primary or hypogonadal osteoporosis (median 10 months of treatment), teriparatide raised lumbar spine bone density in 94% of treated men. ^[1]

Teriparatide side effects and risks

• FDA labelThe label lists arthralgia (joint pain), pain and nausea as the most common adverse reactions, each above 10%. ^[1]
• Animal studyIn rats given daily teriparatide for most of their lives at 3 to 60 times human exposure, osteosarcoma (a bone cancer) rose with dose, reaching 40% to 50% in the high-dose groups. ^[1]
• Human studyIn humans, osteosarcoma has been reported rarely after marketing. Two US claims-database studies found 3 cases among 379,283 users and 0 among 153,316, suggesting a risk similar to comparison groups, though the label says the data call for caution. FDA removed the boxed warning in 2020, but the label still says to avoid use in people with higher baseline risk, such as children with growing bones or after skeletal radiation. ^[1][18]
• FDA labelTransient orthostatic hypotension (a blood-pressure drop on standing) occurred in 5% of healthy volunteers in short-term studies. It typically began within 4 hours of a dose, happened in the first few doses and eased on lying down. ^[1]
• FDA labelTransient high blood calcium 4 to 6 hours after a dose was seen at least once in 11% of women and 6% of men on teriparatide, against 2% and 0% on placebo. Because this can raise the risk of digoxin toxicity, the label advises caution with digoxin. ^[1]
• FDA labelHypersensitivity reactions, including anaphylaxis and angio-oedema, have been reported. Severe hypersensitivity to teriparatide or any of its inactive ingredients is the label's only contraindication. ^[1]

Other things to know

• Original boxed warning: an increased incidence of osteosarcoma was seen in rats given teriparatide at doses roughly 3 to 60 times the human exposure for most of the rat lifespan. Two real-world studies linking pharmacy claims to state cancer registries found no increase in osteosarcoma in human teriparatide users, and FDA removed the boxed warning in November 2020, but kept a warnings-section caution because confounders and long-term human use are incompletely characterised.
• The label says to avoid use in patients at increased baseline osteosarcoma risk: open epiphyses (children, young adults), metabolic bone diseases other than osteoporosis including Paget's disease of bone, prior skeletal radiation therapy, bone metastases or a history of skeletal malignancies, and hereditary disorders predisposing to osteosarcoma. Its only formal contraindication is a history of severe hypersensitivity to teriparatide or any inactive ingredient.
• The label recommends against use for more than 2 years during a patient's lifetime unless the patient remains at, or has returned to, high fracture risk - a prescriber decision, not a fixed rule.
• Transient orthostatic hypotension can occur shortly after injection; the label advises administering the first several doses where the patient can sit or lie down if symptoms occur.
• Sold to consumers as an unlabelled "research" vial outside the approved Forteo and generic supply chain carries none of this label's dosing, quality control or prescriber oversight.

Reported side effects and what the studies measured: Teriparatide side effects.

Where this vial size comes from

Teriparatide is sold as a 750 mcg vial by the pages below, each checked on the date shown. I list them as evidence that this size exists, not as a recommendation to buy from them.

• Kaiser Permanente drug encyclopedia (Forteo)otherLists it as: "Forteo 20 mcg/dose (750 mcg/3 mL) subcutaneous pen injector" · checked 2026-09-28
• 1mg (Terifort, Ipca Laboratories)pharmacyLists it as: "Terifort 750mcg Solution for Injection" - active ingredient "Teriparatide (750mcg)" · checked 2026-09-28

The doses come from the FDA label on the Teriparatide dosing page, and every number on this page is arithmetic on those doses and this vial size.

Questions

How much water do I add to a 750 mcg Teriparatide vial?

There is no single correct amount: water changes how many units a dose is, not how many doses the vial holds. With 2 mL the vial is 0.38 mg/mL and 20 mcg is 5.5 units (0.05 mL) on a U-100 insulin syringe. The units table gives 2, 3, 5 mL.

How many doses are in a 750 mcg Teriparatide vial?

37 doses at 20 mcg.

What does 1 unit equal in a 750 mcg Teriparatide vial?

3.75 mcg with 2 mL, 2.5 mcg with 3 mL, 1.5 mcg with 5 mL of bacteriostatic water, on a U-100 syringe.