Trientine hydrochloride is used to treat Wilson's disease in patients who cannot take the
medication known as Penicillamine. In patients with this condition, the body stores too much
copper. Wilson’s disease is treated with a low copper diet and chelating agents that bind
copper to facilitate its excretion from the body. But unlike penicillamine, this drug is not
recommended in the treatment of cystinuria or rheumatoid arthritis. The absence of a sulfhydryl
moiety renders Trientine hydrochloride incapable of binding cystine and is of no use in
Trientine hydrochloride is marketed under the brand Syprine among others.
Trientine hydrochloride was first launched by Merck, Sharp & Dohme in the U.S. in 1986
under the brand name Syprine for the oral treatment of Wilson's disease. Trientine was
introduced in 1969 as an alternative to D-penicillamine. It has a polyamine-like structure
different from D-penicillamine because it lacks sulfhydryl groups.
Forms and Dosage
Trientine hydrochloride is sold in a capsule and a gelatin-coated capsule. The dosage
recommended in the treatment of Wilson’s disease varies by age. For age above 13 and older
is 750 to 1250 mg, orally. It is divided into doses given 2, 3, or 4 times daily with a
Maximum daily dose capped at 2000 mg. for treatment amongst children younger than 12,
the standard dose is 500 to 750 mg taken orally with a maximum daily dose capped at 1500
The cost of Trientine hydrochloride
In the USA, the cost for Trientine oral capsule 250 mg is $24,105 for a supply of 90 capsules,
depending on the pharmacy and insurance, and other payment plans. The price of the branded
treatment has jumped from $652 in 2010 to $21,267 for 100 pills. The same medication costs
higher still in India, at USD26,000 approximately for a supply of 100 tablets of 250 mg
How does Trientine hydrochloride work?
Trientine chelates excess copper and facilitates its excretion from the body. More recently, it
has been found that trientine may also decrease intestinal copper absorption. However, the
exact mechanism of action of Trientine hydrochloride is unknown. It also inhibits the
absorption and metabolic action of iron and other heavy metals. Trientine produces a
deficiency of copper in some storage pools, even though Wilson’s disease already creates
that in excess.
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