Zinc acetate

Wilson's disease (Wilzin, zinc acetate dihydrate; doses expressed as elemental zinc, available as 25 mg and 50 mg hard capsules). Treatment should be initiated under the supervision of a physician experienced in the treatment of Wilson's disease and is a LIFE-LONG therapy. There is no difference in dose between symptomatic and presymptomatic patients. In all cases the dose should be adjusted according to therapeutic monitoring. Administration: must be taken on an empty stomach, at least 1 hour before or 2–3 hours after meals. In case of gastric intolerance (often with the morning dose), that dose may be delayed to mid-morning, between breakfast and lunch; it may also be taken with a little protein, such as meat. Switching from a chelating agent to zinc for maintenance: the chelating treatment should be maintained and co-administered for 2 to 3 weeks (the time for zinc to induce maximum metallothionein induction and full blockade of copper absorption), and administration of the chelating agent and zinc should be separated by at least 1 hour. Zinc acetate dihydrate is NOT recommended for initial therapy of symptomatic patients because of its slow onset of action — symptomatic patients must first be treated with a chelating agent, with maintenance zinc considered once copper levels are below toxic thresholds and the patient is clinically stable. Caution when switching patients with portal hypertension from a chelating agent. PREGNANCY DOSE: 25 mg three times daily is usually effective, but the dose should be adjusted to copper levels. PAEDIATRIC (age/weight-banded fixed doses, not per-kg, so not held in paedDose): from 1 to 6 years — 25 mg twice daily; from 6 to 16 years if bodyweight under 57 kg — 25 mg three times daily; from 16 years or if bodyweight above 57 kg — 50 mg three times daily. Data are very limited in children under 6 years, but since the disease is fully penetrant, prophylactic treatment should be considered as early as possible. In children unable to swallow capsules, the capsules should be opened and the contents suspended in a little water (possibly sugar- or syrup-flavoured water). Verify all paediatric dosing against a children's formulary. Monitoring targets: plasma free (non-caeruloplasmin) copper below 250 microgram/L and urinary copper excretion below 125 microgram/24 h; urinary zinc above 2 mg/24 h and plasma zinc above 1250 microgram/L generally indicate adequate compliance; overtreatment risks copper deficiency, especially harmful in children and pregnant women, in whom urinary copper should be kept a little above the upper limit of normal or high-normal (40–50 microgram/24 h). Source: eMC SPC for Wilzin 25 mg hard capsules (§4.2). NOTE: the openFDA record fetched for "zinc acetate" is Equate Calaspray (Walmart), an unrelated topical calamine/zinc skin spray — it was NOT used and its directions must not be applied to this page.