Trientine hydrochloride Capsules is an effective therapy for Wilson’s disease (WD). Trientine is a copper-chelating agent, with a polyamine-like structure chemically distinct from penicillamine. It lacks sulfhydryl groups and copper is chelated by forming a stable complex with the 4 constituent nitrogens in a planar ring. Trientine binds to copper in body tissues where it has built up and carries it into the bloodstream and then to the kidneys, which filter it into the urine.
• Remind your patient that WD may be managed effectively with medications and diet. It is crucial that he or she does not stop taking his or her medication if he or she begins to feel better, because WD is a chronic condition that must be managed throughout life.
• Trientine may be right for your patient if he or she has been diagnosed with WD; Trientine is not interchangeable with penicillamine and should be used only by patients who experience intolerable or life-threatening side effects from penicillamine.
• Ask your patient about any allergic reactions he or she might have had while taking Trientine, including rashes or symptoms of asthma or bronchitis. All patients taking Trientine —but especially women—should be frequently tested for anemia. Remind female patients to tell you if they become pregnant, plan to nurse, or plan to become pregnant
• Trientine is contraindicated in patients hypersensitive to Trientine or any components of the formulation. Patients should be observed closely for signs of possible hypersensitivity.
• Patients receiving Trientine should remain under regular medical supervision throughout the period of drug administration. Patients (especially women) should be closely monitored for evidence of iron deficiency anemia.
When determining the correct dosage for your patients, consider how they respond to Trientine. You may advise them to take Trientine 2, 3, or 4 times daily. Trientine should always be taken on an empty stomach, at least 1 hour before meals or 2 hours after meals and at least 1 hour apart from any other drug, food, or milk. The capsules should be swallowed whole with water and not opened or chewed. If any medication comes into contact with the skin, the area should be washed with water right away to avoid development of a rash.
Mineral supplements should not be taken with Trientine , as they can block absorption of Trientine into the bloodstream. A short course of iron supplements may be prescribed to patients with anemia, but these must be taken at least 2 hours apart from Trientine , as iron and Trientine can interfere with each other.
Remind your patient of the importance of following these dosing guidelines because food, mineral supplements, and other medications can interfere with how Trientine is absorbed into the body.
For the first month of treatment, the patient’s temperature should be measured every night and symptoms such as fever or skin rash should be reported.
1. Ala A, Aliu E, Schilsky ML. Prospective pilot study of a single daily dosage of Trientine for the treatment of Wilson disease. Dig Dis Sci. 2015;60(5):1433-1439.
2. Boga S, Jain D, Schilsky ML. Trientine induced colitis during therapy for Wilson disease: a case report and review of the literature. BMC Pharmacol Toxicol. 2015;16:30.
3. Roberts EA, Schilsky ML. AASLD Practice Guidelines. Diagnosis and treatment of Wilson disease: an update. Hepatology. 2008;47(6):2089-2111.
4. National Institute of Diabetes and Digestive and Kidney Diseases. Wilson Disease. http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/wilson-disease/Pages/facts.aspx#sec10. Accessed May 25, 2016.
5. Trientine [package insert]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2014.
Trientine ( Trientine hydrochloride) is indicated in the treatment of patients with Wilson’s disease who are intolerant of penicillamine. Clinical experience with Trientine is limited and alternate dosing regimens have not been well-characterized; all endpoints in determining an individual patient’s dose have not been well defined. Trientine and penicillamine cannot be considered interchangeable. Trientine should be used when continued treatment with penicillamine is no longer possible because of intolerable or life endangering side effects.
Unlike penicillamine, Trientine is not recommended in cystinuria or rheumatoid arthritis. The absence of a sulfhydryl moiety renders it incapable of binding cystine and, therefore, it is of no use in cystinuria. In 15 patients with rheumatoid arthritis, Trientine was reported not to be effective in improving any clinical or biochemical parameter after 12 weeks of treatment.
Trientine is not indicated for treatment of biliary cirrhosis.
• Trientine is contraindicated in patients hypersensitive to Trientine or any components of the formulation. Patients should be observed closely for signs of possible hypersensitivity.
• Patients receiving Trientine should remain under regular medical supervision throughout the period of drug administration. Patients (especially women) should be closely monitored for evidence of iron deficiency anemia.
• The treatment can be monitored by the determination of free copper in the serum. Therapy may be monitored with a 24-hour urinary copper analysis periodically (i.e., every 6-12 months).
• Patients should be directed to take Trientine on an empty stomach, at least one hour before meals or two hours after meals and at least one hour apart from any other drug, food, or milk. The capsules should be swallowed whole with water and should not be opened or chewed. For the first month of treatment, the patient should have his temperature taken nightly, and he should be asked to report any symptom such as fever or skin eruption.
• In general, mineral supplements should not be given since they may block the absorption of Trientine.
• Trientine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
• The following adverse reactions have been reported in a clinical study: iron deficiency, systemic lupus erythematosus. In addition, dystonia, muscular spasm, myasthenia gravis have been reported in marketed use.
Please click here to see full Patient Information for Trientine hydrochloride Capsules.
“Treatment of patients with Trientine Hydrochloride Capsules may be complicated by severe, sometimes lifethreatening, adverse effects. Trientine Hydrochloride Capsules should be administered under the supervision of a physician experienced in the use of this medication for the treatment of sickle cell anemia.”
“Hydroxyurea is mutagenic and clastogenic, and causes cellular transformation to a tumorigenic phenotype. Hydroxyurea is thus unequivocally genotoxic and a presumed transspecies carcinogen which implies a carcinogenic risk to humans. In patients receiving long-term hydroxyurea for myeloproliferative disorders, such as polycythemia vera and thrombocythemia, secondary leukaemia’s have been reported. It is unknown whether this leukemogenic effect is secondary to hydroxyurea or is associated with the patient's underlying disease. The physician and patient must very carefully consider the potential benefits of Trientine Hydrochloride Capsules relative to the undefined risk of developing secondary malignancies. Trientine Hydrochloride Capsules is used to treat chronic myeloid leukaemia or cervical cancer.”
“Your medical team will discuss with you the options for treating your cancer. They will take into account factors such as the type of cancer, where it is, which stage it is at and whether you have had treatment before. The results of blood tests and other investigations will also be considered. How well you feel and how you are likely to cope with treatment is also important.”
“Your cancer treatment will usually consist of a treatment session with Trientine Hydrochloride Capsules followed by a break of a number of days before the next treatment session with Trientine Hydrochloride Capsules. This cycle may be repeated many times as part of your cancer treatment. Trientine Hydrochloride Capsules works by damaging cancer cells in the body. Trientine Hydrochloride Capsules also affects healthy cells and treatment with Trientine Hydrochloride Capsules may damage your immune system. Your medical team may arrange for you to have some blood tests to check how well your immune system is working. Do not share your medicine with other people. It may not be suitable for them and may harm them. The pharmacy label on your medicine tells you how much medicine you should take. It also tells you how often you should take your medicine. This is the dose that you and your prescriber have agreed you should take. You should not change the dose of your medicine unless you are told to do so by your prescriber. If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.
