If you have been prescribed Forteo as part of your osteoporosis treatment, you must be aware of its specific storage instructions. Teriparatide, the active ingredient in Forteo, is a fragile drug that must be refrigerated. Failure to properly store your injection pens can seriously impact the success of your treatment and, ultimately, your health.
So, here's a reminder of Forteo storage instructions and helpful tips to ensure your medicine is safe!
What is Forteo?Forteo is the brand name of Teriparatide, its active ingredient. It's a man-manufactured synthetic form of parathyroid hormone (PTH). The body naturally produces parathyroid hormone to control the calcium level in the blood. Among other things, it stimulates new bone formation and increases bone mineral density.
Forteo is an FDA-approved prescription drug used to treat people with certain forms of osteoporosis when the patient is at high risk of broken bones (fractures) and cannot take other osteoporosis treatments. It is primarily indicated for:
- Postmenopausal women with osteoporosis
- Men with hypogonadal osteoporosis
- Men and women with osteoporosis caused by glucocorticoid medicines like prednisone
It works by increasing bone mass and strength and decreasing the risks of broken bones.
In the U.S., a generic form of Forteo called Bonsity (teriparatide injection) was approved by the FDA in 2019. However, it's not available on the market yet.
Forteo pen injector
Forteo is administered by subcutaneous injection in the thigh or abdomen, usually once daily.
The patient is responsible for self-administering the medicine at home, using a convenient prefilled delivery device called the Forteo pen injector. It connects with disposable needles for each injection.
Your doctor or nurse should have shown you how to use a Forteo pen before sending you home. If you need more clarification, read the user instructions provided with the pen or refer to the online Forteo user manual.
Each Forteo pen injector contains medicine for 28 days with a standard dosage of 20 micrograms daily (your doctor may adjust the dosage depending on your medical situation).
Teriparatide, the active ingredient in Forteo, is a biosimilar medicine. It's a biological product; therefore, it's quite unstable and sensitive to high temperatures and temperature fluctuations.
Like Insulin, Ozempic, Humira, and most other fragile drugs, Forteo must be kept refrigerated and protected from the heat to stay effective. So, let's go through the official storage instructions from Forteo’s manufacturer.
Related article: What are biologics, and what are they used for?
Official storage instructions
According to Eli Lilly and Company, the manufacturer of Forteo, the medicine must be “stored in the refrigerator between 36°F and 46°F (2°C and 8°C) at all times.”
In other words, you must immediately put your Forteo pen back in the fridge after each injection.
Fortunately, there's some room for maneuvering here, as the manufacturer adds that "when traveling and refrigeration is unavailable, the Forteo delivery device can remain at room temperature conditions (77°F / 25°C) for up to a total of 36 hours.”
Once opened, a Forteo pen can be used for up to 28 days maximum (including the first injection day). After 28 days, you must throw it away, even if there’s still medicine inside.
Indeed, laboratory tests have shown that past that time, Teriparatide starts degrading and losing efficiency. As a result, it is not safe for use anymore, even if it has been refrigerated and even if the expiration date printed on the pen hasn't passed yet.
The manufacturer also warns patients to ensure their Forteo pens do not freeze. Freezing temperatures can destroy the medicine inside. Never use Forteo that has been frozen, even temporarily, and even if it has thawed afterward. Throw the pen away and get a new one.
Related article: What happens if insulin freezes?
FAQ about Forteo Storage
Living with refrigerated drugs like Forteo can be stressful and challenging. The success of your osteoporosis treatment depends on the medicine's efficiency, which is highly affected by its storage conditions. To ensure you've got it right, our team of experts answers the most frequently asked questions about storing Forteo.
Does Forteo need to be refrigerated?
Yes, Forteo must be refrigerated at all times, whether your pen is open or not. Ideally, the temperatures inside your domestic refrigerator should be between 36°F to 46°F (2°C to 8°C) with as less fluctuation as possible.
To keep the fridge temperature stable:
- Do not overload the fridge. It could prevent the air from circulating inside and block refrigeration.
- Also, avoid holding the door open for too long.
- Store your Forteo pens at the center of the refrigerator. Avoid the door shelves, bottom, and sides where the temperature fluctuates the most.
- Do not place your medicine near the freezer compartment.
- Check your refrigerator temperature regularly.
Related article: At what temperature should you keep refrigerated medicines
What happens if Forteo is not refrigerated?
Teriparatide, the active ingredient inside your Forteo pen, is a biological product that quickly deteriorates when unrefrigerated. Forteo loses efficiency when left out of the fridge for too long.Eventually, if unrefrigerated for extended periods of time, it may become partially or totally ineffective.
Injecting Forteo that's been unrefrigerated for too long should not poison you, but it can seriously impact your health by significantly lowering your treatment dosage. Therefore, never use a Forteo pen that's been out of the fridge for more than 36 hours or exposed to temperatures over (77°F / 25°C).
How long can Forteo stay at room temperature?
As mentioned above, according to its manufacturer, Forteo can stay at room temperature (below 77°F / 25°C) for a maximum of 36 hours. That should happen only in exceptional cases where refrigeration is impossible, like when traveling, for example.
We recommend using a medical-grade travel cooler when traveling with Forteo pens.
The ones from 4AllFamily can keep your medication refrigerated between 36°F and 46°F (2°C and 8°C) for up to 48 hours when the ambient temperature is 95°F / 35°C and for unlimited time if plugged into a power source like a car cigarette lighter or a portable power bank.
What happens if Forteo gets warm?
Never leave your Forteo pens in direct sunlight, in the car, or near a heat source.
How to tell if your Forteo pen has gone bad?
Can you use expired Forteo?
Are you using Forteo as an osteoporosis treatment? Feel free to comment if you have any doubts about its storage!
 Takács I, Jókai E, Kováts DE, Aradi I. The first biosimilar approved for the treatment of osteoporosis: results of a comparative pharmacokinetic/pharmacodynamic study. Osteoporos Int. 2019 Mar;30(3):675-683. doi: 10.1007/s00198-018-4741-0. Epub 2018 Oct 24. PMID: 30357438; PMCID: PMC6422976. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422976/