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(KOP er)

Index Terms

  • Cupric Chloride
  • Cupric Chloride Dihydrate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral [preservative free]:

Cu-5: 5 mg [dye free]

Solution, Intravenous:

Generic: 0.4 mg/mL (10 mL)

Tablet, Oral:

Coppermin: 5 mg [corn free, rye free, wheat free]

Brand Names: U.S.

  • Coppermin [OTC]
  • Cu-5 [OTC]

Pharmacologic Category

  • Trace Element, Parenteral


Copper is an essential nutrient which serves as a cofactor for serum ceruloplasmin, an oxidase necessary for proper formation of the iron carrier protein, transferrin. It also helps maintain normal rates of red and white blood cell formation and helps prevent development of deficiency symptoms: Leukopenia, neutropenia, anemia, depressed ceruloplasmin levels, impaired transferring formation, secondary iron deficiency and osteoporosis.


Bile (primarily, 80%); intestinal wall (16%); urine (4%)

Use: Labeled Indications

Supplement to intravenous solutions given for total parenteral nutrition (TPN) to maintain copper serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms


There are no contraindications listed in the manufacturer's labeling.

Dosing: Adult

Supplementation: IV (incorporated into parenteral nutrition): 0.3-0.5 mg/day (ASPEN, 2002); 0.5-1.5 mg/day (manufacturer's product labeling)

High output intestinal fistula: Some clinicians may use twice the recommended daily allowance (ASPEN, 2002)

Dosing: Geriatric

Use caution. Start at the low end of dosing range.

Dosing: Pediatric

Supplementation: Infants and Children: IV (incorporated into parenteral nutrition): 20 mcg/kg/day

Dosing: Renal Impairment

Use caution; contains aluminum.

Dosing: Hepatic Impairment

Use caution; dosage reduction may be required.


IV: Must dilute in a volume ≥100 mL.


Must be diluted. Do not administer IM or by direct IV injection; acidic pH of the solution may cause tissue irritation.


Store at controlled room temperature of 20°C to 25°C (68°F to 77°F).

Drug Interactions

Ascorbic Acid: Copper may decrease the serum concentration of Ascorbic Acid. Management: To minimize the risk for ascorbic acid degradation, add multivitamin product to TPN solution immediately prior to infusion or administer multivitamin and copper in separate containers. Consider therapy modification

Adverse Reactions

Generally well tolerated; excessive copper levels may result in the following adverse effect.

Hepatic: Hepatic insufficiency (including hepatic necrosis)


Disease-related concerns:

• Gastrointestinal fistulae: Patients with high output intestinal fistulae may require a larger dose than the recommended daily allowance (ASPEN, 2002).

• Hepatic impairment: Use with caution in patients with hepatic impairment (eg, impaired biliary excretion or cholestatic liver disease).

• Wilson’s disease: Administration not recommended.

Concurrent drug therapy issues:

• TPN preparation: Copper ion may degrade ascorbic acid in TPN solutions. To avoid loss, add multivitamin additives to TPN solutions immediately prior to infusion or add to separate TPN solution container.

Dosage form specific issues:

• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.

Monitoring Parameters

Twice monthly serum assays for copper and/or ceruloplasmin in long-term TPN patients, patients with hepatic failure or high output gastrointestinal fistulas

Pregnancy Risk Factor


Pregnancy Considerations

Animal reproduction studies have not been conducted. It is not known whether administration to a pregnant woman can cause fetal harm or can affect reproductive capacity.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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