Trientine Hydrochloride

Description

DESCRIPTION Trientine hydrochloride is N,N'-bis (2-aminoethyl)-1,2-ethanediamine dihydrochloride. It is a white to pale yellow crystalline hygroscopic powder. It is freely soluble in water, soluble in methanol, slightly soluble in ethanol, and insoluble in chloroform and ether. The empirical formula is C 6 H 18 N 4

What Is Trientine Hydrochloride Used For?

INDICATIONS AND USAGE Trientine Hydrochloride Capsule is indicated in the treatment of patients with Wilson's disease who are intolerant of penicillamine. Clinical experience with Trientine Hydrochloride Capsule 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 Hydrochloride Capsule and penicillamine cannot be considered interchangeable. Trientine hydrochloride Capsule should be used when continued treatment with penicillamine is no longer possible because of intolerable or life endangering side effects. Unlike penicillamine, Trientine Hydrochloride Capsule 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 Hydrochloride Capsule was reported not to be effective in improving any clinical or biochemical parameter after 12 weeks of treatment. Trientine Hydrochloride Capsule is not indicated for treatment of biliary cirrhosis.

Dosage and Administration

DOSAGE AND ADMINISTRATION Systemic evaluation of dose and/or interval between dose has not been done. However, on limited clinical experience, the recommended initial dose of Trientine Hydrochloride Capsule is 500-750 mg/day for pediatric patients and 750-1,250 mg/day for adults given in divided doses two, three or four times daily. This may be increased to a maximum of 2,000 mg/day for adults or 1,500 mg/day for pediatric patients age 12 or under. The daily dose of Trientine Hydrochloride Capsule should be increased only when the clinical response is not adequate or the concentration of free serum copper is persistently above 20 mcg/dL. Optimal long-term maintenance dosage should be determined at 6-12 month intervals (see PRECAUTIONS, Laboratory Tests ). It is important that Trientine Hydrochloride Capsule be given 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.

Side Effects (Adverse Reactions)

ADVERSE REACTIONS Clinical experience with Trientine Hydrochloride Capsule has been limited. The following adverse reactions have been reported in a clinical study in patients with Wilson's disease who were on therapy with trientine hydrochloride: iron deficiency, systemic lupus erythematosus (see CLINICAL PHARMACOLOGY ). In addition, the following adverse reactions have been reported in marketed use: dystonia, muscular spasm, myasthenia gravis. Trientine Hydrochloride Capsule is not indicated for treatment of biliary cirrhosis, but in one study of 4 patients treated with trientine hydrochloride for primary biliary cirrhosis, the following adverse reactions were reported: heartburn; epigastric pain and tenderness; thickening, fissuring and flaking of the skin; hypochromic microcytic anemia; acute gastritis; aphthoid ulcers; abdominal pain; melena; anorexia; malaise; cramps; muscle pain; weakness; rhabdomyolysis. A causal relationship of these reactions to drug therapy could not be rejected or established. To report SUSPECTED ADVERSE REACTIONS, contact Navinta LLC at +1-609-883-1135 or FDA at +1-800-FDA-1088 or www.fda.gov/medwatch.

Drug Interactions

Drug Interactions In general, mineral supplements should not be given since they may block the absorption of Trientine Hydrochloride Capsule. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson's disease. If necessary, iron may be given in short courses, but since iron and Trientine Hydrochloride Capsule each inhibit absorption of the other, two hours should elapse between administration of Trientine Hydrochloride Capsule and iron. It is important that Trientine Hydrochloride Capsule be taken 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. This permits maximum absorption and reduces the likelihood of inactivation of the drug by metal binding in the gastrointestinal tract.

Contraindications

CONTRAINDICATIONS Hypersensitivity to this product.

Pregnancy and Breastfeeding

Pregnancy Category C Trientine hydrochloride was teratogenic in rats at doses similar to the human dose. The frequencies of both resorptions and fetal abnormalities, including hemorrhage and edema, increased while fetal copper levels decreased when trientine hydrochloride was given in the maternal diets of rats. There are no adequate and well-controlled studies in pregnant women. Trientine Hydrochloride Capsule should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Trientine Hydrochloride Capsule is administered to a nursing mother.

Overdosage

OVERDOSAGE There is a report of an adult woman who ingested 30 grams of trientine hydrochloride without apparent ill effects. No other data on overdosage are available.

How Supplied

HOW SUPPLIED Trientine Hydrochloride Capsules, USP 250 mg, are hard gelatin capsules with opaque orange cap imprinted with NAV and opaque white body imprinted with 101 in black ink. They are supplied as follows: NDC 68475-200-01 in bottles of 100.