Trientine


Generic Medicine Info
Indications and Dosage
Oral
Wilson's disease
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.
Patient Counseling Information
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

Chemical Structure Image
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.
MIMS Class
Antidotes & Detoxifying Agents
ATC Classification
A16AX12 - trientine ; Belongs to the class of various alimentary tract and metabolism products.
References
Anon. Trientine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 18/12/2020.

Buckingham R (ed). Trientine Dihydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/12/2020.

Cuprior 150 mg Film-Coated Tablets (Orphalan). European Medicines Agency [online]. Accessed 19/03/2021.

Joint Formulary Committee. Trientine Dihydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/12/2020.

Syprine Capsule (Bausch Health US LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/03/2021.

Trientine Dihydrochloride Capsules 300 mg (Univar Solutions BV). MHRA. https://products.mhra.gov.uk. Accessed 18/12/2020.

Trientine Dihydrochloride Tillomed 250 mg Capsules, Hard (Tillomed Laboratories Ltd). MHRA. https://products.mhra.gov.uk. Accessed 18/12/2020.

Disclaimer: This information is independently developed by MIMS based on Trientine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in