CUPRIC CHLORIDE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CUPRIC CHLORIDE (CUPRIC CHLORIDE).
Copper is an essential trace element that serves as a cofactor for various enzymes, including cytochrome c oxidase (involved in mitochondrial respiration), superoxide dismutase (antioxidant defense), ceruloplasmin (iron metabolism), and lysyl oxidase (collagen cross-linking). It also participates in neurotransmitter synthesis and maintenance of vascular integrity.
| Metabolism | Copper is primarily transported by ceruloplasmin in the blood. Excretion occurs mainly via bile into feces, with minimal urinary elimination. Copper is incorporated into cuproenzymes; excess is conjugated in the liver and excreted in bile. |
| Excretion | Primarily biliary (>80%) into feces; renal excretion accounts for <5% of total copper elimination under normal conditions. |
| Half-life | Terminal half-life is approximately 12-24 hours; clinically relevant for dosing intervals in parenteral nutrition. |
| Protein binding | Approximately 90-95% bound to ceruloplasmin and albumin. |
| Volume of Distribution | 0.3-0.5 L/kg; reflects distribution primarily to liver, kidneys, and plasma. |
| Bioavailability | Intravenous: 100%. Not administered orally for systemic effect; oral bioavailability is approximately 50-70% but variable due to food and other minerals. |
| Onset of Action | Intravenous: Rapid distribution; clinical effect (normalization of serum copper levels) typically within 24-48 hours. |
| Duration of Action | Duration of effect after a single IV dose is several days due to tissue redistribution; repeated dosing may be needed weekly. |
0.5 to 1.5 mg copper (0.14 to 0.42 mg/mL) IV daily as a supplement in TPN; typical adult dose: 0.4 mg copper/day IV.
| Dosage form | INJECTABLE |
| Renal impairment | Not required; copper excretion is primarily biliary. No specific GFR-based adjustments recommended. |
| Liver impairment | Use with caution in severe hepatic impairment (Child-Pugh class C); reduce dose by 50% or monitor copper levels due to impaired biliary excretion. |
| Pediatric use | Neonates and infants: 20 mcg/kg/day IV (max 200 mcg/day); Children: 20-50 mcg/kg/day IV (max 500 mcg/day). |
| Geriatric use | No specific dose adjustment; monitor for copper toxicity (e.g., Wilson disease risk) and renal function decline. Use lowest effective dose. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CUPRIC CHLORIDE (CUPRIC CHLORIDE).
| Breastfeeding | Copper is excreted into breast milk and is a normal constituent. M/P ratio not established. Recommended dietary allowance for lactation is 1.3 mg/day. Supplemental copper should balance maternal deficiency without exceeding requirements; monitor infant for copper overload. |
| Teratogenic Risk | Copper is an essential trace element; deficiency during pregnancy can cause fetal malformations (e.g., skeletal, cardiovascular, CNS defects) and preterm birth. Excessive copper is teratogenic in animal studies. Cupric chloride use should be guided by serum copper levels to avoid deficiency or toxicity. |
■ FDA Black Box Warning
None
| Serious Effects |
Wilson disease; biliary obstruction; known hypersensitivity to copper salts.
| Precautions | Copper accumulation can occur in patients with impaired biliary excretion (e.g., cholestasis, Wilson disease). Use with caution in patients with hepatic impairment. Monitor serum copper and ceruloplasmin levels. Avoid overdose; copper toxicity can lead to hemolysis, liver necrosis, and renal failure. |
| Food/Dietary | No specific food interactions. However, high zinc intake may reduce copper absorption; avoid excessive zinc supplements. |
| Clinical Pearls |
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| Fetal Monitoring | Monitor serum copper, ceruloplasmin, and signs of copper deficiency (anemia, neutropenia) or toxicity (nausea, hepatic injury). In prolonged use, assess fetal growth via ultrasound. |
| Fertility Effects | Copper is required for ovulation and sperm function. Deficiency may impair fertility; excess copper may reduce sperm quality. Therapeutic levels are not associated with adverse fertility effects. |
| Administer cupric chloride intravenously only; avoid IM/SC due to tissue necrosis. Monitor serum copper levels during prolonged TPN use to prevent toxicity. Wilson disease patients must avoid supplementation. Use with caution in hepatic impairment due to copper accumulation risk. |
| Patient Advice | This medication is given intravenously to prevent or treat copper deficiency. · Report any signs of allergic reaction such as rash, itching, or swelling immediately. · Inform your doctor if you have a history of Wilson disease or liver problems. · Regular blood tests may be needed to monitor copper levels. |