Trientine
SYPRINE
Pronunciation: TRYE-en-teen
What it isCopper chelator; Wilson disease in patients intolerant of penicillamine.
Why this oneBetter tolerated than penicillamine with far less autoimmune and marrow toxicity.
What limits itIron deficiency from chelation, and it must be taken on an empty stomach away from iron. Less potent than penicillamine.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Wilson's disease (penicillamine-intolerant) | Adults | 750–1250 mg/day divided BID–QID | — | 2000 mg/day |
| Wilson's disease | Pediatric (age ≤12) | 500–750 mg/day divided BID–QID | — | 1500 mg/day |
Titration Increase only when clinical response is inadequate or free serum copper is persistently above 20 mcg/dL
Renal Undefined
Hepatic Undefined
Reassess optimal long-term maintenance dosage every 6 to 12 months
Instructions
- Take on an empty stomach, at least 1 hour before or 2 hours after meals
- Take at least 1 hour apart from any other drug, food, or milk
- Swallow capsules whole with water; do not open or chew
Available strengths
- cap 250, 500 mg
Cautions
- Iron deficiency (especially children and menstruating/pregnant women)
- Mineral supplements may block absorption — separate iron by 2 hours
- Reported systemic lupus erythematosus
- Reported dystonia, muscular spasm, myasthenia gravis (marketed use)
Adverse reactions
- Iron deficiency
- Systemic lupus erythematosus
- Dystonia
- Muscular spasm
- Myasthenia gravis
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 250 mg | cap | 60 BID | $138.15 | offered |
| 500 mg | cap | 60 BID | not offered |
Generic entry2039 est.
NO BOXED WARNINGS
Principal riskIron deficiency; take on an empty stomach
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityAgent-specific cardiovascular, neurologic or metabolic toxicity requires monitored use in poisoning or overload.