Copper

Dosage Forms & Strengths

capsule

• 5mg

tablet

• 5mg

solution (iv)

• 0.4mg/mL (10mL)

Dietary Supplement

2-5 mg PO qDay or more; not to exceed 8 mg/day

Alternatively (parenteral nutrition): 0.3-0.5 mg/day IV or 0.5-1.5 mg/day IV (per manufacturer)

High Output Fistula

• May use twice the recommended daily allowance

RDA

• Males: 900 mcg/day
• Females: 900 mcg/day
• Pregnant: 1,000 mcg/day
• Nursing: 1,300 mcg/day
• UL (>19 years old): 10,000 mcg/day

Dosage Forms & Strengths

capsule

• 5mg

tablet

• 5mg

solution (iv)

• 0.4mg/mL (10mL)

Dietary Supplement

Parenteral nutrition: 20 mcg copper/kg/day IV

RDA

• 0-6 months old: 200 mcg/day
• 7-12 months old: 220 mcg/day
• 1-3 years old: 340 mcg/day
• 3-8 years old: 440 mcg/day
• 8-13 years old: 700 mcg/day
• 13-18 years old: (Male, Female) 890 mcg/day

Copper is an essential nutrient which serves as a cofactor for serum ceruloplasmin, an oxidase necessary for proper formation of the iron carrier protein, transferrin. Copper also helps maintain normal rates of red and white blood cell formation.

Providing Copper during TPN helps prevent development of the following deficiency symptoms: Leukopenia, neutropenia, anemia, depressed ceruloplasmin levels, impaired transferrin formation, secondary iron deficiency and osteoporosis.

Normal serum Copper values range from 80 to 163 mcg/dl (mean, approximately 110 mcg/dl). The serum Copper level at which deficiency symptoms appear is not precisely defined. A serum value of 9 mcg Copper/dl was reported for one TPN patient who received no Copper. The daily turnover of Copper through ceruloplasmin is approximately 0.5 mg. Excretion of Copper is through the bile (80%), directly through the intestinal wall (16%) and in urine (4%).

None known.

Copper 0.4 mg/mL (Cupric Chloride Injection, USP) contains 0.4 mg Copper/mL and is administered intravenously only after dilution. The additive should be diluted in a volume of fluid not less than 100 mL. For the adult receiving TPN, the suggested additive dosage is 0.5 to 1.5 mg Copper/day (1.25 to 3.75 mL/day). For pediatric patients, the suggested additive dosage is 20 mcg Copper/kg/day (0.05 mL/kg/day). Infants weighing less than 1500 gm may have increased requirements because of their low body reserves and increased requirements for growth.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. (See PRECAUTIONS.)

(KOP er)

Use caution. Start at the low end of dosing range.

Supplementation: Infants and Children: IV (incorporated into parenteral nutrition): 20 mcg/kg/day

Use caution; contains aluminum.

Ascorbic Acid: Copper may decrease the serum concentration of Ascorbic Acid. Management: To minimize the risk for ascorbic acid degradation, add multivitamin product to TPN solution immediately prior to infusion or administer multivitamin and copper in separate containers. Consider therapy modification

Twice monthly serum assays for copper and/or ceruloplasmin in long-term TPN patients, patients with hepatic failure or high output gastrointestinal fistulas