Version July 2025
Adequate intake (AI): Note: Recommended intake from dietary sources (eg, breast milk, formula).
Neonates: Oral: 200 mcg/day (~30 mcg/kg/day) (Ref).
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 (Ref).
Infants and Children weighing 10 to 40 kg: IV: 20 mcg/kg/day; maximum daily dose: 500 mcg/day (Ref).
Children and Adolescents weighing >40 kg: IV: 200 to 500 mcg/day (Ref).
There are no dosage adjustments provided in the manufacturer's labeling. However, use caution; parenteral product 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 (Ref); 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 (Ref).
(For additional information see "Copper supplements (including parenteral nutrition additive): Drug information")
Dietary supplement: Oral: 2 mg daily. Maximum: 8 mg daily.
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 (Ref).
There are no adverse reactions listed in the manufacturer’s labeling.
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:
• 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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 0.4 mg/mL (10 mL)
Yes
Solution (Cupric Chloride Intravenous)
0.4 mg/mL (per mL): $3.14 - $3.81
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Micro-Cu: 0.4 mg/mL (10 mL)
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.
IV: Must be diluted. Do not administer IM or by direct IV injection; acidic pH of the solution may cause tissue irritation.
Store at controlled room temperature of 20°C to 25°C (68°F to 77°F).
Oral: Dietary supplement (FDA approved in adults).
Parenteral: Additive to parenteral nutrition (PN) to maintain copper serum concentrations and to prevent depletion of endogenous stores and subsequent deficiency (FDA approved in pediatric patients [age not specified] and adults).
Cupric sulfate may be confused with calcium gluconate
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
There are no known significant interactions.
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.
Animal reproduction studies have not been conducted.
Copper and/or ceruloplasmin serum concentrations in patients receiving long-term parenteral nutrition (twice monthly as recommended by manufacturer), and patients with burns, cholestasis, hepatic failure, or high output GI fistulas (ASPEN [Corkins 2015]; ASPEN [Vanek 2012]; manufacturer's labeling); superoxide dismutase activity, urine copper, and free copper may be helpful; however, availability is limited in clinical practice; confirm tests are available prior to collection (Berger 2023; ESPGHAN/ESPEN/ESPR/CSPEN [Domellöf 2018]; Zemrani 2018).
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%)
