Palopegteriparatide
YORVIPATH
Pronunciation: pal-oe-peg-ter-i-PAR-a-tide (YOR-vi-path)
What it isA long-acting prodrug of PTH(1-34) that releases active parathyroid hormone continuously from a once-daily injection, for chronic hypoparathyroidism.
Why this oneContinuous physiologic PTH exposure is the point: most patients can come off therapeutic calcium and active vitamin D entirely, rather than chasing levels with supplements.
What limits itHypo- or hypercalcemia can follow titration, interruption, or supplement changes; frequent calcium monitoring guides adjustment.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypoparathyroidism | adults | 18 mcg SC QD | individualized to normal serum calcium (titrate by 3 mcg) | 30 mcg QD |
Titration Titrate in 3 mcg increments/decrements; measure serum calcium 7–10 days after any dose change.
Renal No adjustment for mild, moderate, or severe impairment (eGFR ≥15 mL/min/1.73 m2).
Hepatic Undefined
Instructions
- Use only one SC injection to achieve the once-daily dose (two injections increase serum-calcium variability).
- Confirm serum 25(OH)D normal and albumin-corrected calcium ≥7.8 mg/dL within 2 weeks before first dose.
- Adjust active vitamin D and calcium supplements on initiation/up-titration.
Available strengths
- inj 0.168, 0.294, 0.42 mg
Cautions
- Hypersensitivity reactions (anaphylaxis, angioedema, urticaria)
- Unintended serum calcium changes with two daily injections
- Serious hypercalcemia
- Serious hypocalcemia
- Potential risk of osteosarcoma
- Orthostatic hypotension
- Digoxin toxicity with concomitant use if hypercalcemia develops
Adverse reactions
- Injection site reactions
- Hypocalcemia
- Hypercalcemia
- Headache
- Diarrhea
- Paresthesia/hypoesthesia
Pregnancy Insufficient data to identify drug-associated risk; disease-associated risks from maternal/fetal hypocalcemia in pregnancy.
Lactation No data on presence in milk; monitor breastfed infant for hypercalcemia or hypocalcemia.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 0.168 mg | inj | per unit | not offered | |
| 0.294 mg | inj | per unit | not offered | |
| 0.42 mg | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskSerious hypercalcemia or hypocalcemia
Classes and tags
Clinical profile
Legacy pregnancy categoryN/A (post-2015 labeling)
Defining liabilitySerious hypercalcemia or hypocalcemia during titration or interruption