trientine (Rx)

Brand and Other Names:Syprine, Clovique
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 250mg

Wilson Disease

Indicated for treatment of Wilson Disease in patients intolerant of penicillamine

750-1250 mg/day PO divided q6-12hr

Increase dose if clinical response not adequate or free serum copper persistently >20 mcg/dL; not to exceed 2 g/day

Reassess long-term maintenance dose q6-12Months

Dosing Considerations

Limitations of use

  • Not recommended in cystinuria or rheumatoid arthritis
  • Not indicated for biliary cirrhosis

Manganism (Orphan)

Designated for treatment of manganism

Orphan sponsor

  • Biovail Technologies, Ltd; 700 Route 202/206 North; Bridgewater, NJ 08807

Wilson Disease (Orphan)

New salt form: trientine tetrahydrochloride

Orphan designation for treatment of Wilson Disease

Orphan sponsor

  • GMP-Orphan SAS; Voisin Consulting, Inc; 222 Third Street, Suite 3121; Cambridge, Massachusetts 02142

Dosage Forms & Strengths

capsule

  • 250mg

Wilson Disease

<12 years

  • 500-750 mg/day PO divided q6-12hr; not to exceed 1.5 g/day

≥12 years

  • For patients intolerant of penicillamine: 750-1250 mg/day PO divided q6-12hr; not to exceed 2 g/day
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Interactions

Interaction Checker

and trientine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (26)

                • acetazolamide

                  acetazolamide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • bendroflumethiazide

                  bendroflumethiazide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • bumetanide

                  bumetanide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • carbonyl iron

                  trientine, carbonyl iron. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • chlorothiazide

                  chlorothiazide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • chlorthalidone

                  chlorthalidone decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • cyclopenthiazide

                  cyclopenthiazide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • ethacrynic acid

                  ethacrynic acid decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • ferric maltol

                  trientine, ferric maltol. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • ferrous fumarate

                  trientine, ferrous fumarate. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • ferrous gluconate

                  trientine, ferrous gluconate. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • ferrous sulfate

                  trientine, ferrous sulfate. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • furosemide

                  furosemide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • hydrochlorothiazide

                  hydrochlorothiazide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • indapamide

                  indapamide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • iron dextran complex

                  trientine, iron dextran complex. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • iron sucrose

                  trientine, iron sucrose. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • magnesium supplement

                  magnesium supplement will decrease the level or effect of trientine by Other (see comment). Modify Therapy/Monitor Closely. Formation of an insoluble complex reduces absorption of the drug through intestinal tract; administer magnesium 1hr before the trietine or 1hr after the trientine

                • methyclothiazide

                  methyclothiazide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • metolazone

                  metolazone decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                • polysaccharide iron

                  trientine, polysaccharide iron. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • rose hips

                  trientine, rose hips. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

                • selenium

                  selenium will decrease the level or effect of trientine by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer trientine at least 1 hr before or after polyvalent cations (2 hr if oral iron administered).

                • sodium sulfate/?magnesium sulfate/potassium chloride

                  sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of trientine by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer trientine at least 1 hr before and after each dose to avoid chelation with magnesium. .

                • sodium sulfate/potassium sulfate/magnesium sulfate

                  sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of trientine by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer trientine at least 1 hr before and after each dose to avoid chelation with magnesium. .

                • torsemide

                  torsemide decreases levels of trientine by increasing renal clearance. Use Caution/Monitor.

                Minor (1)

                • copper

                  trientine decreases levels of copper by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Indicated action (for Wilson's disease).

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                Adverse Effects

                Frequency Not Defined

                Dystonia

                Iron deficiency

                Rash; thickening and fissuring of skin

                Muscular spasm

                Myasthenia gravis

                SLE

                Abdominal pain

                Gastritis

                Aphthoid ulcer

                Anorexia

                Colitis

                Heartburn

                Loss of taste

                Aplastic anemia

                Sideroblastic anemia

                Lupus like eruption

                Myasthenia gravis

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                Warnings

                Contraindications

                Hypersensitivity to product or components

                Cautions

                Not indicated for cystinuria, RA (cf penicillamine) or biliary cirrhosis

                May cause iron deficiency anemia

                Hepatic iron oveload may result from copper deficiency induced by therapy

                Monitor urinary copper and for signs of hypersensitivity (eg, elevated body temperature)

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                Pregnancy & Lactation

                Pregnancy Category: C

                Lactation: Excretioin in breast milk unknown; use caution

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Oral chelating agent used to induce adequate cupriuresis

                Pharmacokinetics

                Absorption: Poor

                Excretion: Urine (9%)

                Metabolite: Acetyltrien

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                Administration

                Oral Administration

                Take on empty stomach 1 hr before or 2 hr after meals

                Take at least 1 hr apart from any drug, food, or milk

                Swallow capsule whole with water; do not open or chew

                Any skin exposed to capsule contents should be promptly washed

                Storage

                Refrigerate at 2-8ºC (36-46F)

                After dispensing: Clovique may be stored at room temperature for up to 30 days

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Syprine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                trientine oral
                -
                250 mg capsule
                Clovique oral
                -
                250 mg capsule

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                trientine oral

                TRIENTINE - ORAL

                (TRYE-en-teen)

                COMMON BRAND NAME(S): Syprine

                USES: This medication is used to treat a certain inherited disorder (Wilson's disease). This disorder causes too much copper to build up in the liver, brain, and other parts of the body. Trientine works by binding to copper, which helps your body get rid of extra copper. This can decrease symptoms such as problems with speech/swallowing/coordination, tiredness, lack of appetite, abdominal pain, yellowing eyes/skin, fluid buildup in the legs/abdomen, uncontrolled movements, or muscle stiffness.

                HOW TO USE: Take this medication by mouth on an empty stomach, at least 1 hour before meals or 2 hours after meals as directed by your doctor, usually 2 to 4 times daily. Take this medication at least 1 hour apart from any other drug, food, or milk. Swallow the capsules whole with water. Do not open or chew the capsules. The dosage is based on your medical condition and response to treatment.For the best effect, follow a low-copper diet as directed by your doctor and take this medication regularly. To help you remember, take it at the same times each day.For the first month of treatment, check your temperature every night and tell your doctor of any fever or rash.If your doctor directs you to also take an iron supplement, take it at least 2 hours before or after trientine.Tell your doctor if your condition does not get better or if it gets worse.If you accidentally come in contact with the capsule contents, wash the area promptly with water to avoid an allergic reaction.

                SIDE EFFECTS: Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication and a low-copper diet may increase the risk for iron deficiency. Tell your doctor right away if you have symptoms such as feeling very tired, weakness, pale skin, chest pain, fast heartbeat, shortness of breath, cold hands/feet. Your doctor may direct you to take an iron supplement for a short time (see also How to Use section).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before taking trientine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain immune disease (systemic lupus erythematosus).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children and pregnant or menstruating women may be at greater risk for developing iron deficiency while taking this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood/urine copper levels) should be done while you are taking this medication. Keep all medical and lab appointments.

                MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

                STORAGE: Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

                Information last revised September 2020. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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