Trientine Hydrochloride

Pronunciation: (TRY-eh-TEEN HIGH-droe-KLOR-ide)
Class: Chelating agent

Trade Names

Syprine
- Capsules 250 mg

Pharmacology

Forms chelate with copper, facilitating removal from the body.

Indications and Usage

Treatment of Wilson disease in patients intolerant of penicillamine.

Contraindications

Standard considerations.

Dosage and Administration

Adults

PO Initially, 750 to 1,250 mg/day in divided doses 2, 3, or 4 times daily (max, 2,000 mg/day).

Children 12 yr of age and younger

PO Initially, 500 to 750 mg/day in divided doses 2, 3, or 4 times daily (max, 1500 mg/day).

Storage/Stability

Store capsules in refrigerator (36° to 46°F). Keep container tightly closed.

Drug Interactions

Mineral supplements

In general, do not give mineral supplements because they may block the absorption of trientine. Because iron deficiency may develop, iron may be given in short courses if necessary, separating the administration times of iron and trientine by 2 h.

Food, other drugs

To permit max absorption, administer trientine on an empty stomach at least 1 h before or 2 h after meals and at least 1 h apart from any other drug, food, or milk.

Laboratory Test Interactions

None well documented.

Adverse Reactions

CNS

Malaise; weakness.

Dermatologic

Thickening, fissuring, and flaking of the skin.

GI

Heartburn; epigastric pain and tenderness; acute gastritis; abdominal pain; anorexia; cramps.

Hematologic

Hypochromic microcytic anemia.

Metabolic

Iron deficiency.

Respiratory

Asthma; bronchitis.

Miscellaneous

System lupus erythematosus; dystonia; muscular spasm; myasthenia gravis; aphthoid ulcers; melena; muscle pain; rhabdomyolysis.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established; however, trientine has been used clinically in children as young as 6 yr of age without reported adverse reactions.

Elderly

Use with caution because of the greater frequency of decreased hepatic, renal, or cardiac function and concomitant diseases or other drug therapy.

Hypersensitivity

Although not reported, observe patients for signs of possible hypersensitivity.

Patient Information

• Remind patient or caregiver that following a low-copper diet is an important part of therapy and that medication therapy will be continued for months to years.
• Advise patient or caregiver that each dose should be taken with a full glass of water on an empty stomach, 1 h before or 2 h after meals and at least 1 h apart from any other drug, food, or milk. Advise patient who is also taking iron supplements to separate trientine and iron administration by at least 2 h.
• Advise patient or caregiver that capsules should be swallowed whole. Do not crush, chew, cut, or open capsules.
• Advise patient or caregiver that if accidental skin contact occurs with contents of capsule to immediately flush exposed skin with water to remove medication.
• Instruct patient or caregiver to take and record temperature each night for the first month of therapy and to report any fever or elevated temperature to health care provider.
• Instruct patient or caregiver to immediately report skin rash or eruption to health care provider.
• Instruct patient not to take any prescription or OTC medications or dietary supplements, including mineral supplements, unless advised by health care provider.

Copyright © 2009 Wolters Kluwer Health.