Trientine is a chelating agent used primarily in the treatment of Wilson’s disease, a genetic disorder of copper metabolism. It helps remove excess copper from the body by binding to it and increasing its excretion in urine. Trientine is generally prescribed when patients cannot tolerate penicillamine therapy. The drug reduces copper accumulation in vital organs such as the liver and brain. It is administered orally in capsule form. Trientine works gradually and requires long-term use for effective control of the disease. Regular monitoring of copper levels is necessary during treatment. Common side effects are usually mild compared to other chelators. Trientine plays a crucial role in preventing copper-related tissue damage. Overall, it is an important alternative therapy in Wilson’s disease management.
BRAND NAMES
Syprine®
Cufence®
Trientine Dihydrochloride (generic)
Trientine Waymade®
Trientine Mylan®
MECHANISM OF ACTION
Trientine acts as a copper-chelating agent. It binds free copper ions in the body to form a stable complex. This complex is water-soluble and easily excreted in urine. By removing excess copper, trientine prevents copper accumulation in tissues. It reduces copper deposition in organs like the liver and brain. This helps prevent progressive organ damage. The drug does not interfere with normal metal ions significantly.
PHARMACOKINETICS
Absorption
Trientine is moderately absorbed from the gastrointestinal tract. Absorption is reduced when taken with food. Therefore, it is recommended to take it on an empty stomach. Peak plasma levels are reached within a few hours. Absorption can vary among individuals. Poor absorption may reduce effectiveness. Proper timing improves therapeutic outcomes.
Distribution
Once absorbed, trientine is distributed throughout the body. It reaches tissues with excess copper accumulation. The drug has low plasma protein binding. It readily interacts with free copper in blood and tissues. Distribution allows effective copper chelation. Trientine does not significantly accumulate in tissues. This limits long-term toxicity.
Metabolism
Trientine undergoes minimal metabolism in the body. It is converted into acetylated metabolites. These metabolites also possess copper-binding ability. Liver metabolism plays a minor role. The parent drug remains active for chelation. Metabolic pathways are not fully extensive. This reduces the risk of metabolic drug interactions.
Excretion
Excretion of trientine occurs mainly through urine. Copper bound to trientine is eliminated in urinary form. A small amount is excreted in feces. Renal function plays a key role in elimination. Regular urinary copper monitoring is required. Excretion increases copper clearance. This supports long-term disease control.
PHARMACODYNAMICS
Trientine lowers free copper levels in the body. It reduces toxic copper accumulation in organs. This improves liver and neurological function. Clinical improvement occurs gradually. Pharmacodynamic effects depend on dose and duration. Continuous therapy is necessary. The effect is maintained with regular use.
ADMINISTRATION
Trientine is administered orally in capsule form. It should be taken on an empty stomach. Doses are usually divided throughout the day. Capsules should be swallowed whole. Treatment is long-term and continuous. Patients require regular monitoring. Compliance is essential for effectiveness.
DOSAGE AND STRENGTH
Trientine is commonly available as 250 mg capsules. Dosage varies depending on disease severity. Adults usually require divided daily doses. Pediatric doses are adjusted based on body weight. Dose adjustments may be needed over time. Therapy is individualized. Medical supervision is necessary during dosing.
DRUG INTERACTIONS
Trientine may interact with iron supplements. Iron should be taken at least two hours apart. It may reduce the absorption of other metal-containing drugs. Concurrent use with zinc requires caution. Combining chelating agents increases risk of mineral imbalance. Monitoring is essential during combination therapy. Always inform healthcare providers of all medications.
FOOD INTERACTIONS
Food significantly reduces trientine absorption. It should be taken at least one hour before meals. Dairy products may interfere with absorption. Mineral-rich foods can reduce effectiveness. Patients should follow strict timing instructions. Consistent administration improves results. Dietary counseling may be helpful.
CONTRAINDICATIONS
Trientine is contraindicated in patients with hypersensitivity to the drug. It should be used cautiously in severe renal impairment. Patients with anemia require careful monitoring. Use during pregnancy only if clearly needed. Breastfeeding requires medical advice. Contraindications are relatively few. Risk–benefit assessment is essential.
SIDE EFFECTS
Gastrointestinal problems: Abdominal discomfort or cramping, nausea, diarrhea, constipation, altered bowel patterns, and reduced appetite.
Skin-related reactions: Rashes, itching, and hair thinning or hair loss.
Psychological effects: Changes in mood or emotional state.
OVER DOSE
Overdose of trientine is rare. Excess dosing may increase mineral deficiency risk. Symptoms may include gastrointestinal upset. There is no specific antidote. Treatment is supportive and symptomatic. Monitoring of copper and blood levels is required. Medical attention should be sought immediately.
TOXICITY
Trientine has relatively low toxicity. Long-term use may cause copper deficiency if overdosed. Hematological toxicity is uncommon but possible. Liver and kidney functions should be monitored. Toxic effects are dose-dependent. Proper dosing minimizes risks. Regular laboratory tests ensure safety.
