Trientine

What is Trientine

Trientine is an oral chelating agent that is used for the treatment of Wilson’s disease (hepatolenticular degeneration).

Trientine is a copper chelator, but trientine is only indicated for use in patients who have intolerance to penicillamine, which is another copper chelator.

Of 41 patients who got trientine because of d-penicillamine intolerance, 34 improved, 4 had no change in clinical global response, 2 were lost to follow-up, and 1 had deterioration in clinical condition.

Trientine is considered to be a safer alternative to d-penicillamine; few side effects have been reported, but clinical trial data are limited. Of 13 patients who developed intolerance to d-penicillamine and began trientine, 8 had their signs and symptoms of intolerance disappear, 4 patients had improvement, and 1 patient had no change during trientine receipt.

Initial treatment of symptomatic patients with penicillamine or trientine is recommended in the guidelines for Wilson’s disease developed by the American Association for the Study of Liver Diseases.

Penicillamine, trientine, or zinc is recommended for the initial treatment with of presymptomatic patients or for the maintenance treatment of successfully treated symptomatic patients. Lifelong treatment is needed unless a liver transplantation has been performed.

Trientine is not useful for cystinuria, as trientine does not contain a sulfhydryl moiety and, thus, cannot bind cystine. Trientine is also not recommended for the treatment of rheumatoid arthritis; in a small study, trientine for 12 weeks was found to be ineffective. Trientine was approved by the FDA in 1985.

Brand Names

  • CLOVIQUE
  • Syprine

Indications

  • Wilson’s disease

Side Effects

  1. abdominal pain
  2. anemia
  3. arthralgia
  4. colitis
  5. contact dermatitis
  6. diarrhea
  7. hemosiderosis
  8. lupus-like symptoms
  9. pyrosis (heartburn)
  10. rash
  11. sideroblastic anemia
  12. thrombocytopenia
  13. zinc deficiency

Monitoring Parameters

  • CBC
  • ferritin
  • hemoglobin/hematocrit
  • INR
  • LFTs
  • serum iron
  • urinalysis

Contraindications

  • anemia
  • biliary cirrhosis
  • breast-feeding
  • children
  • gelatin hypersensitivity
  • geriatric
  • hemochromatosis
  • infants
  • iron-deficiency anemia
  • neonates
  • pregnancy
  • sideroblastic anemia

Interactions

  • food
  • Minerals

Food: (Major) Take trientine either 1 hour before food or 2 hours after food and at least 1 hour apart from milk in order to minimize the likelihood of trientine inactivation by metal binding in the gastrointestinal tract. 

Minerals: (Major) In general, oral mineral supplements should not be given since they may block the oral absorption of trientine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson’s disease. If necessary, iron may be given in short courses, but since iron and trientine each inhibit oral absorption of the other, 2 hours should elapse between administration of trientine and iron doses. 

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