Trientine

How it works

It chelates copper and promotes its urinary excretion, reducing the toxic copper accumulation characteristic of Wilson's disease.

Prescribing in practice

• Different trientine salt formulations are not interchangeable on a milligram basis and switching requires care, as inadequate treatment risks neurological and hepatic deterioration.
• It can cause iron deficiency through reduced iron absorption, and any iron supplementation should be separated in time from trientine.
• It should be taken on an empty stomach away from food, milk and other medicines to preserve absorption; refer to the SPC.

Monitoring

Copper status (such as urinary copper and non-caeruloplasmin copper), full blood count for iron deficiency, and clinical response are monitored regularly.

Counselling the patient

• Take this medicine on an empty stomach, separated from food and other tablets, exactly as directed.
• Do not take iron supplements at the same time of day as trientine.
• Keep taking it continuously, as stopping can cause your condition to worsen.

Evidence & guidelines

Trientine is an established second-line chelator for Wilson's disease supported by long-standing clinical use.