Kauliv

Posology The recommended dose of Kauliv is 20 micrograms administered once daily. Patients should receive supplemental calcium and vitamin D supplements if dietary intake is inadequate. 4). The 24-month course of teriparatide should not be repeated over a patient’s lifetime.

Following cessation of teriparatide therapy, patients may be continued on other osteoporosis therapies. 2). 3). In patients with moderate renal impairment, teriparatide should be used with caution. No special caution is required for patients with mild renal impairment.

3). Therefore, teriparatide should be used with caution. Paediatric population and young adults with open epiphyses The safety and efficacy of teriparatide in children and adolescents less than 18 years have not been established. Teriparatide should not be used in paediatric patients (less than 18 years), or young adults with open epiphyses.

Method of administration Kauliv should be administered once daily by subcutaneous injection in the thigh or abdomen. 6). 6). Instructions for use which is included in the carton of the pen are also available to instruct patients on the correct use of the pen.

Summary of the safety profile The most commonly reported adverse reactions in patients treated with teriparatide are nausea, pain in limbs, headache and dizziness. 5% of the placebo patients reported at least 1 adverse event. 5 The adverse reactions associated with the use of teriparatide in osteoporosis clinical trials and post- marketing exposure are summarised in the table below.

The following convention has been used for the classification of the adverse reactions: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1 000 to <1/100), and rare (≥1/10 000 to <1/1 000). Table 1. 25 mmol/L Psychiatric disorders Common Depression Nervous system disorders Common Dizziness, headache, sciatica, syncope Ear and labyrinth disorders Common Vertigo Cardiac disorders Common Palpitations Uncommon Tachycardia Vascular disorders Common Hypotension Respiratory, thoracic and mediastinal disorders Common Dyspnoea Uncommon Emphysema Gastrointestinal disorders Common Nausea, vomiting, hiatus hernia, gastro-oesophageal reflux disease Uncommon Haemorrhoids Skin and subcutaneous tissue disorders Common Sweating increased Musculoskeletal and connective tissue disorders Very common Pain in limb Common Muscle cramps Uncommon Myalgia, arthralgia, back cramp/pain* *Serious cases of back cramp or pain have been reported within minutes of the injection.

Description of selected adverse reactions In clinical trials the following reactions were reported at a ≥1% difference in frequency from placebo: vertigo, nausea, pain in limb, dizziness, depression, dyspnoea. Teriparatide increases serum uric acid concentrations.

7% of placebo patients. However, the hyperuricaemia did not result in an increase in gout, arthralgia, or urolithiasis. Anti-drug antibodies if any are likely to be observed in line with other teriparatide containing medicinal products.

There was no evidence of hypersensitivity reactions, allergic reactions, effects on serum calcium, or effects on Bone Mineral Density (BMD) response. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.

Traceability In order to improve the traceability of biological medicinal products, the name and the batch number of the administered medicinal product should be clearly recorded. Serum and urine calcium In normocalcaemic patients, slight and transient elevations of serum calcium concentrations have been observed following teriparatide injection.

Serum calcium concentrations reach a maximum between 4 and 6 hours and return to baseline by 16 to 24 hours after each dose of teriparatide. Therefore, if blood samples for serum calcium measurements are taken, this should be done at least 16 hours after the most recent teriparatide injection.

Routine calcium monitoring during therapy is not required. Teriparatide may cause small increases in urinary calcium excretion, but the incidence of hypercalciuria did not differ from that in the placebo-treated patients in clinical trials.

3 Urolithiasis Teriparatide has not been studied in patients with active urolithiasis. Teriparatide should be used with caution in patients with active or recent urolithiasis because of the potential to exacerbate this condition. Orthostatic hypotension In short-term clinical trials with teriparatide, isolated episodes of transient orthostatic hypotension were observed.

Typically, an event began within 4 hours of dosing and spontaneously resolved within a few minutes to a few hours. When transient orthostatic hypotension occurred, it happened within the first several doses, was relieved by placing subjects in a reclining position, and did not preclude continued treatment.

Renal impairment Caution should be exercised in patients with moderate renal impairment. 1). Treatment should only be initiated if the benefit clearly outweighs risks in this population. Women of childbearing potential should use effective methods of contraception during use of teriparatide.

If pregnancy occurs, teriparatide should be discontinued. 3). Until further clinical data become available, the recommended treatment time of 24 months should not be exceeded. Excipients This medicinal product contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially “sodium-free”.

1. 6). Pre-existing hypercalcaemia. Severe renal impairment. Metabolic bone diseases (including hyperparathyroidism and Paget’s disease of the bone) other than primary osteoporosis or glucocorticoid-induced osteoporosis. Unexplained elevations of alkaline phosphatase.

Prior external beam or implant radiation therapy to the skeleton. Patients with skeletal malignancies or bone metastases should be excluded from treatment with teriparatide.