Quantity of medication Forteo pin administers with "one click"

Sorry to hear that you are having a hard time with forteo. It took me about one and half months to get used to it. Hope you could gradually adjust into it. What’s the worst side effect that’s hard for you?

I felt the clicks that I heard when administering forteo is a bit random and the clicks mostly occurs towards the end of pushing the plunger. It might $be hard to quantify the amount.

If you have a pen that’s near end of usage, like 27-28 days old, you could try to play around since there will be some liquid med remaining.

Most of the literatures I read on forteo had 20, 40, and 80mcg tested, so I guess 20mcg is the minimum effective dose. It would be nice forteo pen has a set titration clicks like tymlos pen does.

Best wishes

Hi maybin,

Lots of different side effects.

Strangest, I think, is the fact that it was will tolerated in the beginning. (Started 12/27/2023)

Today it’s headache, fatigue, unsteady on my feet.

This after a three day holiday,
I felt fine and resumed Forteo.

Gave myself a shot last night and today headache and fatigue.

Earlier my feet and calves swelled, a calcium lump (I think) appeared on the fourth toe below that throbbed all night. Plus insomnia all night.

Lump resolved right away.

Doctor suggested every other day.

Have you been checking your blood pressure? Mine dropped to low 80s/lo 50s (my normal was low100s/mid60s), which made me very fatigued all day long, even though I injected before bedtime. Lots of time I had to lie down to feel comfortable. The thing helped I think was lot of water (10-12 cups throughout the day) and adding salt when needed. After one and half months or so I felt totally normal. I guess I was lucky not having any other symptoms.

You probably know forteo is known to increase blood calcium transiently. My blood calcium was increased to 10.5 for a few months then went down afterwards. Recently I switched to AM injection and noticed blood calcium would increase within a few hours of injection. The high calcium level didn't cause any symptoms for me though.

Headache and insomnia could be side effects, but they don't appear to be remarkably increased (insomnia slightly increased) compared to non-forteo treated population according to package
insert. I think it could be serious when blood pressure gets too low. Dizziness could occur, and syncope if it occurs, could be very serious.

Every other day dosing seems a very good idea. If all your symptoms occurred only after starting of forteo, and they persists, that will be concerning.

Best wishes

Maybe you could switch to Tymlos which is similar in its action but has actual "clicks" on the pen to measure doses 1/8 at a time. You could try a half dose and move up.

20mcg
You might want to stop the drug to retest kidney function.

One of the effects of Forteo is vasodilation which can cause headaches. Since salt has an equally immediate effect of vasoconstriction, you maybe able to circumvent the headache by indulging in your favorite salty food before injecting. Be sure too, that you have enough calcium in your system. I usually take calcium 2hours before to make sure it is in the bloodstream. And you need to be hydrated. The blood pressure drop is immediate and dramatic. Best to lay low for a couple of hours after injection so that you don't fall.
The drug clears the system quickly. Symptoms thee days later might an allergic reaction to the drug, but having positive effect for many months that you should stop to assess serum and urine calcium. Teriparatide can adversely affect the kidneys.
You could watch the plunger and play with the dose that way, though every other day is probably be therapeutic long term.

Salty food and hydrate. You can also buy a home blood pressure cuff. I did that with Tymlos at first.

I was told that Forteo and Tymlos do not affect the kidneys. However, since they temporarily raise calcium levels, they can cause kidney stones (not common, but it happens). So don't take too much calcium.

These meds, which work in a similar but slightly different way through the parathyroid, can lower blood pressure which in turn might, conceivably, affect a kidney filtration test (eGFR) but only very short term (hours). But if you have blood tests, in the am, do Forteo/Tymlos after the test, not before, or at least 4 hours apart.

Hypercalcemia can be asymtomatic or physiologically unpleasant. While hypercalcemia is usually transcient beginning 4 to 6 hours after injection, and resolving in 16 to 24 hours, in the literature there are cases of longer term hypercalcemia with the use of Forteo.
It is possible in some patients to reduce the intake of calcium and/or D3 to resolve the issue.
Hypercalcemia can lead to arthritis, bone pain, osteomalacia, peptic ulcer disease, osteoporosis.
Some patients begin the drug without prior testing for evidence of hypercalcemia--possibly the secondary cause of osteoporosis.

My blood calcium increased from baseline 9.7 to 10.5 for months 1-6 after starting forteo. Afterwards, it came back to pretreatment level. The most recent one in Feb this year also was high at 10.4, I think its due to the blood was taken 4 hours after injection. Hope the changes in calcium levels were as expected.

gently and windyshores: you both suggested reducing calcium intake amount could mitigate the increase in blood level. How much would you say is an appropriate amount of reduction when hyperglycemia occurs? Also, has either of you heard of adjusted calcium level and the usage of it?

Question for gently - could you explain your intake of calcium 2 hours prior to forteo injection? I dont quite understand it, since there will be a transient intra-day increase of calcium 4-6 hours post forteo injection. Thanks