Adult: In patients who are intolerant of penicillamine: As trientine dihydrochloride cap: 1,200-2,400 mg daily in 2-4 divided doses. Alternatively, 750-1,250 mg daily in 2-4 divided doses (Max: 2,000 mg daily). As trientine tetrahydrochloride tab: 450-975 mg daily in 2-4 divided doses. Initiate at the lowest dose in the range and adjust according to patient response and serum copper level. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines). Child: In patients who are intolerant of penicillamine: ≥5 years As trientine dihydrochloride cap: Initially, 20 mg/kg daily rounded off to the nearest 250 mg cap given in 2-3 divided doses. Alternatively, 500-750 mg daily in divided doses (Max: 1,500 mg daily). As trientine tetrahydrochloride tab: 225-600 mg daily in 2-4 divided doses. Adjust dose according to patient response and serum copper level. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines). Elderly: As trientine dihydrochloride cap: May initiate at the lower end of the dosing range.
Administration
Should be taken on an empty stomach. Take at least 1 hr before or 2 hr after meals, & at least 1 hr before or after any other medicine, food or milk.
Special Precautions
Patient with pre-existing neurological symptoms. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Fe deficiency anaemia; copper deficiency, sideroblastic anaemia; neurologic worsening; SLE. Gastrointestinal disorders: Nausea, gastritis, duodenitis, colitis (including severe colitis). Musculoskeletal and connective tissue disorders: Muscle spasm, myasthenia gravis, dystonia. Skin and subcutaneous tissue disorders: Rash, pruritus, erythema, urticaria.
Do not switch between brands or dosage forms unless instructed by your doctor, as different brands or dosage forms may contain different amounts of trientine base.
Monitoring Parameters
Monitor for fever and skin changes during the 1st month of therapy; changes in neurological status; evidence of Fe deficiency anaemia (particularly in women). Perform 24-hour urinary copper assessment periodically (every 6-12 months). Monitor serum non-ceruloplasmin bound copper, LFTs, CBC, INR, urinalysis.
Drug Interactions
Trientine and Fe may each inhibit the absorption of the other.
Food Interaction
May result in chelation when given with food, dairy products, or other sources of polyvalent cations.
Action
Description: Trientine is an oral chelating agent. It is used to eliminate absorbed copper from the body through the formation of a stable complex that is eventually excreted from the kidney. It may also inhibit copper absorption by chelation in the intestinal tract.
Synonym: trientine dihydrochloride: trientine hydrochloride. Pharmacokinetics: Absorption: Rapidly but poorly absorbed from the gastrointestinal tract. Time to peak plasma concentration: 1.25-2 hours. Distribution: Volume of distribution: 393 L (central); 252 L (peripheral). Metabolism: Extensively metabolised via acetylation into major metabolites, N1-acetyltriethylenetetramine and N1, N10-diacetyltriethylenetetramine. Excretion: Via urine (1% as unchanged drug; 8% as metabolite). Elimination half-life: 2-4 hours.
Chemical Structure
Trientine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5565, Triethylenetetramine. https://pubchem.ncbi.nlm.nih.gov/compound/Triethylenetetramine. Accessed Mar. 25, 2021.
Storage
Cap: Store between 2-8°C. Do not freeze. Storage recommendations may vary among countries and individual products. Refer to specific product guidelines.
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