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Trientine tetrahydrochloride oral

Updated 2 Feb 2023 | Wilson's disease


Oral formulations of trientine tetrahydrochloride.

Drugs List

  • CUPRIOR 150mg tablets
  • trientine (as tetrahydrochloride) 150mg tablets
  • Therapeutic Indications


    Wilson's disease

    Treatment of Wilson's disease in patients intolerant to penicillamine therapy.


    The doses are expressed as mg of trientine base (ie. not in mg of the trientine tetrahydrochloride salt).


    450mg to 975mg (3 to 6.5 tablets) daily in 2 to 4 divided doses.

    Adjust the dosage according to the patient's clinical response and serum copper levels.


    The starting dose in paediatrics is lower than for adults and depends on age and body weight.

    Children aged 5 years and over
    225mg to 600mg (1.5 to 4 tablets) daily in 2 to 4 divided doses and serum copper levels.


    Children under 5 years

    Precautions and Warnings

    Renal impairment

    May not resolve penicillamine-induced systemic lupus erythematosus
    Treatment to be prescribed under the supervision of a specialist
    Advise patient to take on an empty stomach 1 hr before or 2 hrs after food
    Monitor copper levels
    Monitor neurological function
    Monitor renal function in patients with renal impairment
    Neonate exposed in utero: Monitor serum copper concentrations
    Pregnancy: Monitor maternal serum copper concentrations
    Iron supplements may be required if iron deficiency occurs
    Bioavailability differs with preparations;caution on changing formulations
    Avoid antacids at the same time as this medicine
    Avoid iron supplements within 2hrs of dose

    Caution is advised when switching a patient from another trientine formulation. Tablets and capsules are not interchangeable due to differences in bioavailability.

    Monitor for manifestations of overtreatment as this carries the risk of copper deficiency.

    It is recommended to monitor patients closely for signs and symptoms of neurological deterioration in order to optimise the dose.

    Pregnancy and Lactation


    Use trientine dihydrochloride with caution during pregnancy.

    The manufacturer recommends trientine tetrahydrochloride is not used in pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus. Animal studies have shown reproductive toxicity, although likely to be a result of trientine-induced copper deficiency. At the time of writing there is limited human data available. Risks are unknown. If use cannot be avoided the pregnancy should be monitored in order to detect possible foetal abnormality and to assess maternal serum copper levels throughout the pregnancy. The dose of trientine should be adjusted to maintain serum copper levels within the normal range. Babies born to mothers being treated with trientine should be monitored for serum copper and ceruloplasmin levels where appropriate.


    Trientine tetrahydrochloride is contraindicated during breastfeeding.

    The manufacturer advises that the patient either discontinues trientine tetrahydrochloride or discontinues breastfeeding. The presence of trientine tetrahydrochloride in human breast milk and the effects on exposed infants are unknown. Copper deficiency, however, is a potential toxicity.

    Side Effects

    Iron deficiency anaemia


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2019

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Cuprior 150 mg film-coated tablets. GMP-Orphan United Kingdom Ltd. Revised September 2017.

    NICE Evidence Services Available at: Last accessed: 08 April 2022.

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