Trientine
**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.
Mecanismo: 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.
Dosificación por especie
- As a chelator for copper hepatotoxicity · 10-15 mg/kg · PO · q12h · 1-2 hours before a meal
- As a chelator for copper hepatotoxicity · 10-15 mg/kg · PO · q12h · Give one hour before meals
- As a chelator for copper hepatotoxicity · 15-30 mg/kg · PO · q12h · Give prior to meals
- Copper hepatotoxicosis · 10-15 mg/kg · PO · q12h · Long-term as needed · Vomiting may be reduced by giving in divided doses with food.
Las dosis son una referencia clínica para veterinarios colegiados. Confirme siempre con la ficha técnica vigente y el paciente individual.
Vías de administración
Contraindicaciones
- 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.
Efectos adversos
- 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)
Interacciones farmacológicas
- Iron · Iron and trientine mutually inhibit the absorption of one another. Separate doses by at least 2 hours.
- Zinc · Trientine may chelate zinc and other essential minerals, reducing their absorption. Separate doses by at least 2 hours.
- Iron supplements · Inhibits absorption of iron; separate doses by a minimum of 2 hours · moderate
- Zinc supplements · Inhibits absorption of zinc; separate doses by a minimum of 2 hours · moderate
- Other mineral supplements · Inhibits absorption of minerals; separate doses by a minimum of 2 hours · moderate
Monitorización
- 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
Sobredosis
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.
La referencia de fármacos de VetSheet está destinada a veterinarios colegiados como apoyo a la decisión clínica, no sustituye el juicio profesional ni la ficha técnica vigente del fabricante.