Dietary supplement: Oral: 2 mg daily. Maximum: 8 mg daily.
Parenteral nutrition additive, maintenance requirement: IV: 0.3 to 0.5 mg/day (ASPEN [Vanek 2012]).
High output intestinal fistula: Some clinicians may use twice the recommended daily allowance (ASPEN 2002).
There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; contains parenteral aluminum.
There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; in patients with significant cholestasis or hepatic dysfunction, a dosage reduction (~50%) or discontinuation may be required (ASPEN [Corkins 2015]; ASPEN [Vanek 2012]).
(For additional information see "Copper supplements (including parenteral nutrition additive): Pediatric drug information")
Parenteral nutrition additive, maintenance requirement (ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]; ASPEN [Vanek 2012]): Note: Higher doses may be needed in patients with deficiency and increased requirements. IV:
Infants <10 kg: 20 mcg/kg/day
Infants and Children weighing 10 to 40 kg: 5 to 20 mcg/kg/day; maximum daily dose: 500 mcg/day
Children and Adolescents weighing >40 kg: 200 to 500 mcg/day
There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; contains aluminum.
There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; in patients with significant cholestasis or hepatic dysfunction, a dosage reduction (~50%) or discontinuation may be required (ASPEN [Corkins 2015]; ASPEN [Vanek 2012]).
Use caution. Start at the low end of dosing range.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral [preservative free]:
Cu-5: 5 mg [dye free]
Solution, Intravenous:
Generic: 0.4 mg/mL (10 mL)
Tablet, Oral:
Coppermin: 5 mg [DSC] [corn free, rye free, wheat free]
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Micro-Cu: 0.4 mg/mL (10 mL)
IV: Must be diluted. Do not administer IM or by direct IV injection; acidic pH of the solution may cause tissue irritation.
Parenteral: Not for direct IV or IM injection; must be diluted prior to administration; direct administration of 0.4 mg/mL solution causes tissue irritation
Dietary supplementation: Trace element added to parenteral nutrition (PN) to prevent copper deficiency; orally as a dietary supplement.
Cupric sulfate may be confused with calcium gluconate
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Generally well tolerated; excessive copper levels may result in the following adverse effect.
Hepatic: Hepatic insufficiency (including hepatic necrosis)
There are no contraindications listed in the manufacturer's labeling.
Disease-related concerns:
• Gastrointestinal fistulae: Patients with high output intestinal fistulae may require a larger dose than the recommended daily allowance (ASPEN, 2002).
• Hepatic impairment: Use with caution in patients with hepatic impairment (eg, impaired biliary excretion or cholestatic liver disease).
• Wilson's disease: Administration not recommended.
Concurrent drug therapy issues:
• TPN preparation: Copper ion may degrade ascorbic acid in TPN solutions. To avoid loss, add multivitamin additives to TPN solutions immediately prior to infusion or add to separate TPN solution container.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer's labeling.
None known.
There are no known significant interactions.
Animal reproduction studies have not been conducted.
It is unknown whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised.
Dietary adequate intake (AI) (IOM 2001):
1 to 6 months of age: 200 mcg/day (~30 mcg/kg/day)
7 to 12 months of age: 220 mcg/day (~24 mcg/kg/day)
Dietary recommended daily allowances (RDA) (IOM 2001):
1 to 3 years of age: 340 mcg/day
4 to 8 years of age: 440 mcg/day
9 to 13 years of age: 700 mcg/day
14 to 18 years of age: 890 mcg/day
>18 years: 900 mcg/day
Pregnancy: 1,000 mcg/day
Lactation: 1,300 mcg/day
Copper and/or ceruloplasmin serum concentrations in long-term parenteral nutrition patients (twice monthly) and patients with burns, cholestasis, hepatic failure, or high output gastrointestinal fistulas (ASPEN [Vanek 2012])
Serum levels: 0.7-1.5 mcg/mL
Copper is an essential nutrient which serves as a cofactor for serum ceruloplasmin, an oxidase necessary for proper formation of the iron carrier protein, transferrin. It also helps maintain normal rates of red and white blood cell formation and helps prevent development of deficiency symptoms: Leukopenia, neutropenia, anemia, depressed ceruloplasmin levels, impaired transferring formation, secondary iron deficiency and osteoporosis.
Excretion: Bile (primarily, 80%); intestinal wall (16%); urine (4%)
Solution (Cupric Chloride Intravenous)
0.4 mg/mL (per mL): $2.60
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