Medically reviewed on Nov 15, 2018
- Cupric Chloride
- Cupric Chloride Dihydrate
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral [preservative free]:
Cu-5: 5 mg [dye free]
Generic: 0.4 mg/mL (10 mL)
Coppermin: 5 mg [corn free, rye free, wheat free]
Brand Names: U.S.
- Coppermin [OTC]
- Cu-5 [OTC]
- 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
Trace element added to parenteral nutrition (PN) to prevent copper deficiency; orally as a dietary supplement
There are no contraindications listed in the manufacturer's labeling.
Parenteral nutrition additive, maintenance requirement (ASPEN [Vanek 2012]): IV: 0.3 to 0.5 mg/day
High output intestinal fistula: Some clinicians may use twice the recommended daily allowance (ASPEN 2002)
Use caution. Start at the low end of dosing range.
Parenteral nutrition additive, maintenance requirement (ASPEN [Mirtallo 2004]): IV: Note: Higher doses may be needed in patients with deficiency and increased requirements.
Infants <10 kg: 20 mcg/kg/day
Infants and Children weighing 10 to 40 kg: 5 to 20 mcg/kg/day; maximum daily dose: 500 mcg/day
Children and Adolescents weighing >40 kg: 200 to 500 mcg/day
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; contains parenteral aluminum.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; in pediatric and adult patients with significant cholestasis or hepatic dysfunction, a dosage reduction (~50%) or discontinuation may be required (ASPEN [Corkins 2015]; ASPEN [Vanek 2012]).
IV: Must dilute in a volume ≥100 mL.
IV: Must be diluted. Do not administer IM or by direct IV injection; acidic pH of the solution may cause tissue irritation.
Dietary adequate intake (AI) (IOM 2001):
1 to 6 months of age: 200 mcg/day (~30 mcg/kg/day)
7 to 12 months of age: 220 mg/day (~24 mcg/kg/day)
Dietary recommended daily allowances (RDA) (IOM 2001):
1 to 3 years of age: 340 mcg/day
4 to 8 years of age: 440 mcg/day
9 to 13 years of age: 700 mcg/day
14 to 18 years of age: 890 mcg/day
>18 years: 900 mcg/day
Pregnancy: 1,000 mcg/day
Lactation: 1,300 mcg/day
Store at controlled room temperature of 20°C to 25°C (68°F to 77°F).
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
Generally well tolerated; excessive copper levels may result in the following adverse effect.
Hepatic: Hepatic insufficiency (including hepatic necrosis)
• 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.
Copper and/or ceruloplasmin serum concentrations in long-term parenteral nutrition patients (twice monthly) and patients with burns, cholestasis, hepatic failure, or high output gastrointestinal fistulas (ASPEN [Vanek 2012])
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.
• 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.
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