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Copper supplements (including parenteral nutrition additive): Drug information

Copper supplements (including parenteral nutrition additive): Drug information
(For additional information see "Copper supplements (including parenteral nutrition additive): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Coppermin [OTC] [DSC]
Brand Names: Canada
  • Micro-Cu
Pharmacologic Category
  • Trace Element, Parenteral
Dosing: Adult
Dietary supplement

Dietary supplement: Oral: 2 mg daily. Maximum: 8 mg daily.

Parenteral nutrition additive, maintenance requirement

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).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; contains parenteral aluminum.

Dosing: Hepatic Impairment: Adult

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]).

Dosing: Older Adult

Use caution. Start at the low end of dosing range.

Dosing: Pediatric

(For additional information see "Copper supplements (including parenteral nutrition additive): Pediatric drug information")

Parenteral nutrition additive, maintenance requirement

Parenteral nutrition additive, maintenance requirement: Note: Higher doses may be needed in patients with deficiency and increased requirements.

Infants weighing <10 kg: IV: 20 mcg/kg/day (ASPEN 2020; ESPGHAN/ESPEN/ESPR/CSPEN [Domellöf 2018]).

Infants and Children weighing 10 to 40 kg: IV: 20 mcg/kg/day; maximum daily dose: 500 mcg/day (ASPEN 2020; ESPGHAN/ESPEN/ESPR/CSPEN [Domellöf 2018]).

Children and Adolescents weighing >40 kg: IV: 200 to 500 mcg/day (ASPEN 2020).

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; parenteral product contains aluminum.

Dosing: Hepatic Impairment: Pediatric

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]); some reports suggest infants with cholestasis may become deficient when copper is reduced or eliminated from parenteral nutrition and indicated some patients may require higher doses; monitor copper levels (Corkins 2013).

Adverse Reactions

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)

Contraindications

There are no contraindications listed in the manufacturer's labeling.

Warnings/Precautions

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:

• Parenteral nutrition preparation: Copper ion may degrade ascorbic acid in parenteral nutrition (PN) solutions. To avoid loss, add multivitamin additives to PN solutions immediately prior to infusion or add to separate PN 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.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous:

Generic: 0.4 mg/mL (10 mL)

Tablet, Oral:

Coppermin: 5 mg [DSC] [corn free, rye free, wheat free]

Generic Equivalent Available: US

May be product dependent

Pricing: US

Solution (Cupric Chloride Intravenous)

0.4 mg/mL (per mL): $3.14 - $3.46

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Micro-Cu: 0.4 mg/mL (10 mL)

Administration: Adult

IV: Must be diluted. Do not administer IM or by direct IV injection; acidic pH of the solution may cause tissue irritation.

Administration: Pediatric

Parenteral: Not for direct IV or IM injection; must be diluted prior to administration; due to its acidic pH, direct administration of 0.4 mg/mL solution may cause tissue irritation.

Use: Labeled Indications

Dietary supplementation: Trace element added to parenteral nutrition (PN) to prevent copper deficiency; orally as a dietary supplement.

Medication Safety Issues
Sound-alike/look-alike issues:

Cupric sulfate may be confused with calcium gluconate

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Pregnancy Considerations

Animal reproduction studies have not been conducted.

Breastfeeding Considerations

It is unknown whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised.

Dietary Considerations

Dietary reference intake (IOM 2001):

1 to 6 months: Adequate intake (AI): 200 mcg/day (~30 mcg/kg/day).

7 to 12 months: AI: 220 mcg/day (~24 mcg/kg/day).

1 to 3 years: Recommended dietary allowance (RDA): 340 mcg/day.

4 to 8 years: RDA: 440 mcg/day.

9 to 13 years: RDA: 700 mcg/day.

14 to 18 years: RDA: 890 mcg/day.

>18 years: RDA: 900 mcg/day.

Pregnancy: RDA: 1,000 mcg/day.

Lactation: RDA: 1,300 mcg/day.

Monitoring Parameters

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])

Reference Range

Serum levels: 0.7-1.5 mcg/mL

Mechanism of Action

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.

Pharmacokinetics (Adult Data Unless Noted)

Excretion: Bile (primarily, 80%); intestinal wall (16%); urine (4%)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (BE) Belgium: Levoligo;
  • (BR) Brazil: Cobre | Cobre quelato | Sidney oliveira cobre;
  • (DE) Germany: Alpha kupfer | Copper Bisglycinate | Cuprimit | Hypo 11a Kupfer | Kupfer | Kupfer citrat | Kupfer-glukon | Naturasan Kupfer | Nicapur Kupfer;
  • (EE) Estonia: Kelasin cu;
  • (FR) France: Remoplexe;
  • (LB) Lebanon: Gnc copper;
  • (LT) Lithuania: Bertil's kelasin copper | Bertil's kelasin varis | Cobre;
  • (LV) Latvia: Kelasin cu;
  • (NZ) New Zealand: Solgar chelated copper
  1. Aluminum in large and small volume parenterals used in total parenteral nutrition. Fed Regist. 2002;67(244):77792-77793. To be codified at 21 CFR §201.323.
  2. American Society for Parenteral and Enteral Nutrition (ASPEN). Appropriate dosing for parenteral nutrition: ASPEN recommendations. http://www.nutritioncare.org/PNDosing. Updated November 17, 2020. Accessed January 10, 2023.
  3. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002;26(1 Suppl):1-138. [PubMed 11841046]
  4. Berger MM, Talwar D, Shenkin A. Pitfalls in the interpretation of blood tests used to assess and monitor micronutrient nutrition status. Nutr Clin Pract. 2023;38(1):56-69. doi:10.1002/ncp.10924 [PubMed 36335431]
  5. Copper [prescribing information]. Lake Forest, IL: Hospira; September 2017.
  6. Copper [prescribing information]. Long Island City, NY: Freeda; received 2011.
  7. Copper [prescribing information]. Long Island City, NY: Freeda; received 2012.
  8. Copper Caps [prescribing information]. American Fork, UT: Twinlab; received 2011.
  9. Coppermin (copper) [prescribing information]. St. Louis, MO: The Key Company; no date.
  10. Corkins MR, Balint J, Bobo E, et al. The A.S.P.E.N Pediatric Nutrition Support Core Curriculum. Silver Spring, MD: American Society of Parenteral and Enteral Nutrition; 2015.
  11. Corkins MR, Martin VA, Szeszycki EE. Copper levels in cholestatic infants on parenteral nutrition. JPEN J Parenter Enteral Nutr. 2013;37(1):92-96. doi:10.1177/0148607112443069 [PubMed 22610978]
  12. Cu-5 (copper) [prescribing information]. Fayetteville, AR: Bio-Tech; no date.
  13. Domellöf M, Szitanyi P, Simchowitz V, Franz A, Mimouni F; ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Iron and trace minerals. Clin Nutr. 2018;37(6, pt B):2354-2359. doi:10.1016/j.clnu.2018.06.949 [PubMed 30078716]
  14. Institute of Medicine (IOM) (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academies Press; 2001. Available at https://www.ncbi.nlm.nih.gov/books/NBK222310/. [PubMed 25057538]
  15. National Institutes of Health (NIH). Copper: fact sheet for health professionals. https://ods.od.nih.gov/factsheets/Copper-HealthProfessional/. Updated October 18, 2022. Accessed December 1, 2023.
  16. Natures Plus Copper (copper) [prescribing information]. Amityville, NY: Natural Organics Laboratories, Inc.; no date.
  17. Vanek VW, Borum P, Buchman A, et al. A.S.P.E.N. position paper: recommendations for changes in commercially available parenteral multivitamin and multi-trace element products. Nutr Clin Pract. 2012;27(4):440-491. [PubMed 22730042]
  18. Zemrani B, McCallum Z, Bines JE. Trace element provision in parenteral nutrition in children: one size does not fit all. Nutrients. 2018;10(11):1819. doi:10.3390/nu10111819 [PubMed 30469420]
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