Trientine
Trientine hydrochloride
Also known as: Syprine · Metalite · Cufence · MK-0681 · 2,2,2-tetramine · trien hydrochloride · triethylenetetramine dihydrochloride · trientine hydrochloride · TETA
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As a chelator for copper hepatotoxicity | 10-15 mg/kg | PO | q12h | — | 🌎 NA |
| As a chelator for copper hepatotoxicity | 10-15 mg/kg | PO | q12h | — | 🌎 NA |
| As a chelator for copper hepatotoxicity | 15-30 mg/kg | PO | q12h | — | 🌎 NA |
| Copper hepatotoxicosis | 10-15 mg/kg | PO | q12h | Long-term as needed | 🌍 EU |
- As a chelator for copper hepatotoxicity: 1-2 hours before a meal
- As a chelator for copper hepatotoxicity: Give one hour before meals
- As a chelator for copper hepatotoxicity: Give prior to meals
- Copper hepatotoxicosis: Vomiting may be reduced by giving in divided doses with food.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Trientine is an oral copper chelating agent primarily utilized in veterinary medicine for the management of copper-associated hepatopathy in dogs.
Certain breeds, such as Bedlington Terriers, Labrador Retrievers, and Dalmatians, have a genetic predisposition to accumulate toxic levels of copper in their liver, leading to chronic hepatitis. Trientine serves as a critical alternative therapy when patients cannot tolerate the gastrointestinal adverse effects (such as severe vomiting) commonly associated with the first-line chelator, penicillamine.
Clinical Pearl: Trientine is generally more expensive than penicillamine and often requires compounding into smaller capsule sizes for veterinary patients. It is highly hygroscopic and must be handled and stored carefully.
Mechanism of action
Trientine acts as a polyamine chelating agent. It binds to systemic copper to form a stable, water-soluble complex (a chelate) that is subsequently eliminated from the body via urinary excretion.
- Affinity Profile: Trientine has a greater affinity for plasma copper compared to penicillamine.
- Conversely, penicillamine has a higher affinity for tissue copper.
- By binding circulating copper, trientine creates a concentration gradient that gradually pulls stored copper out of hepatic tissues for elimination.
Safety & warnings
Contraindications
- Hypersensitivity to trientine
- Cystinuria
- Rheumatoid arthritis
- Biliary cirrhosis
- No specific contraindications available in the monograph, but should be used with caution in patients without confirmed copper storage disease.
Adverse effects
- Acute renal failure (rare but reported in dogs)
- Iron deficiency anemia (with long-term use)
- Topical contact dermatitis (if powder contacts skin)
- Nausea
- Vomiting
- Abdominal pain
- Melaena (dark, tarry stools)
- Weakness
- Copper deficiency (with chronic therapy)
Precautions
Teratogenicity: Trientine is a potential teratogen (FDA Category C). It should only be used in pregnant animals when the benefits to the mother clearly outweigh the risks to the offspring. Exercise caution in nursing patients.
Handling Warning: The drug can cause topical dermatitis. It must be given in an intact capsule and should never be opened or sprinkled on food. If the powder accidentally contacts human or animal skin, wash the area immediately with water.
Drug interactions
Iron and trientine mutually inhibit the absorption of one another. Separate doses by at least 2 hours.
Trientine may chelate zinc and other essential minerals, reducing their absorption. Separate doses by at least 2 hours.
Inhibits absorption of iron; separate doses by a minimum of 2 hours
Inhibits absorption of zinc; separate doses by a minimum of 2 hours
Inhibits absorption of minerals; separate doses by a minimum of 2 hours
Monitoring
- Periodic quantitative hepatic copper levels (via liver biopsy)
- Renal function parameters (BUN, Creatinine, SDMA, Urinalysis) due to the risk of acute renal failure
- Complete Blood Count (CBC) to monitor for iron deficiency anemia
- Hepatic copper concentrations (via biopsy)
- Liver enzymes (ALT, AST, ALP)
- Clinical signs of copper deficiency (e.g., anemia, weakness)
- Gastrointestinal tolerance
Pharmacokinetics
Absorption
Poorly absorbed from the gastrointestinal tract.
Distribution
Widely distributed, but has greater affinity for plasma copper than tissue copper.
Metabolism
Metabolized via acetylation.
Elimination
Excreted primarily in the urine as a copper-trientine complex.
Overdose
Little information is available regarding acute toxicity in veterinary species. In human medicine, a case of a patient ingesting 30 grams of trientine without significant morbidity has been reported. If a massive overdose occurs in a pet, standard gastrointestinal decontamination and supportive care are recommended.
Available products
Formulations
- Capsules
- 250 mg capsule
- 300 mg capsule
Human-labeled
- Trientine HCl Oral Capsules: 250 mg
- 250 mg capsule
- 300 mg capsule
Regulatory status
POM (Prescription Only Medicine). Human orphan drug used off-label under the cascade.
POM (Prescription Only Medicine).
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store trientine capsules in the refrigerator (2-8°C) in tightly closed containers. The powder is highly hygroscopic (absorbs moisture from the air).
Client information
- Administration: It is best to give this medication on an empty stomach (1 to 2 hours before a meal) to maximize its effectiveness.
- GI Upset: If giving it on an empty stomach causes your pet to vomit or lose their appetite, you may give it with a very small amount of food to settle the stomach.
- Handling Precaution: Do not open the capsules or sprinkle the powder on your pet's food. The powder can cause skin irritation. If the powder accidentally gets on your skin or your pet's skin, wash it off immediately with soap and water.
- Storage: Keep the medication stored in the refrigerator in a tightly closed container.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.