CUPRIC SULFATE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CUPRIC SULFATE (CUPRIC SULFATE).
Copper is an essential trace element that serves as a cofactor for various enzymes involved in iron metabolism, connective tissue formation, and antioxidant defense. Cupric sulfate replaces copper in deficient states, enabling proper erythropoiesis, neurological function, and collagen synthesis.
| Metabolism | Copper is absorbed in the small intestine, transported to the liver bound to albumin and transcuprein, and incorporated into ceruloplasmin. Excretion is primarily biliary; small amounts are eliminated in urine. |
| Excretion | Primarily fecal (biliary excretion of copper) ~80%; renal excretion accounts for ~2-5% of a dose under normal conditions; small amounts lost in sweat and desquamated skin. |
| Half-life | Terminal elimination half-life of copper is 12-24 hours for the rapid phase, but a slower phase of 3-5 days reflects redistribution from tissues; clinical context: used for copper deficiency or as an emetic. |
| Protein binding | Approximately 90-95% bound to ceruloplasmin and albumin; minor binding to transcuprein and metallothionein. |
| Volume of Distribution | ~0.5-1 L/kg, indicating distribution into extracellular fluid and tissues such as liver, kidney, and bone marrow. |
| Bioavailability | Oral: 30-50% (dependent on dietary factors and intestinal transporter activity); intravenous: 100%; not administered intramuscularly due to irritant properties. |
| Onset of Action | As an emetic: 5-10 minutes after oral administration; intravenous administration for copper deficiency: immediate rise in serum copper. |
| Duration of Action | Emetic effect lasts 30-60 minutes; for copper replacement, effect persists as long as copper stores are replenished; redistribution half-life extends tissue effects for days. |
For copper supplementation in total parenteral nutrition: 0.3-0.5 mg intravenously daily. For topical antifungal/antibacterial use: apply 2% solution or 0.1% ointment to affected area twice daily. For emetic use: 0.5-2 mg orally as a single dose.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment guidelines; use with caution in severe renal impairment due to potential copper accumulation. GFR <30 mL/min: consider reducing dose or increasing interval based on serum copper monitoring. |
| Liver impairment | No specific dose adjustment guidelines for Child-Pugh classification; use with caution in hepatic impairment due to altered copper metabolism. Monitor serum copper levels. |
| Pediatric use | For total parenteral nutrition: 20-40 mcg/kg/day intravenously; maximum 0.5 mg/day. Topical: apply sparingly. Emetic use not recommended. |
| Geriatric use | No specific dose adjustment; use lower end of dosing range due to potential age-related decline in renal function and increased risk of copper accumulation. Monitor serum copper levels. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CUPRIC SULFATE (CUPRIC SULFATE).
| Breastfeeding | Copper is a normal constituent of breast milk and essential for infant development. Cupric sulfate is excreted into milk; the M/P ratio is approximately 0.1. At therapeutic doses, exposure to the infant through milk is minimal and not expected to cause adverse effects. |
| Teratogenic Risk | No evidence of teratogenicity in humans. Animal studies do not indicate teratogenic effects at therapeutic doses. However, copper deficiency during pregnancy is associated with fetal growth restriction and congenital abnormalities. Overdose (e.g., Wilson disease treatment errors) may cause fetal toxicity. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to copper sulfate","Wilson's disease (unless indicated for maintenance therapy under expert supervision)","Acute copper toxicity states"]
| Precautions | ["Acute copper toxicity may cause nausea, vomiting, hepatic necrosis, and renal failure","Chronic overdose can lead to Wilson's disease-like symptoms","Use with caution in patients with cholestatic disorders or hepatic impairment","Monitor serum copper and ceruloplasmin levels"] |
| Food/Dietary | Avoid high-copper foods (e.g., liver, shellfish, nuts, chocolate, mushrooms) if using for copper overload conditions. No specific food interactions for topical use. |
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| Fetal Monitoring | Monitor maternal serum copper and ceruloplasmin levels every 1-3 months during pregnancy to ensure levels remain within therapeutic range for Wilson disease (target: 200-400 μg/L). Monitor for signs of copper deficiency (e.g., pancytopenia, neuropathy) or toxicity (e.g., hepatotoxicity). In fetus/neonate, assess development due to risk of deficiency-induced abnormalities. |
| Fertility Effects | Copper is essential for reproductive function. Both deficiency and excess copper can impair fertility. Correction of copper deficiency or excess (as in Wilson disease) often restores normal fertility. No direct contraceptive or fertility-enhancing effects. |
| Clinical Pearls |
| Cupric sulfate is used topically as an astringent and antifungal. For Wilson disease, oral cupric sulfate is contraindicated; instead use trientine or penicillamine. Monitor for hemolysis if accidental overdose. Do not administer intramuscularly or subcutaneously due to severe local necrosis. In ophthalmic use, use only diluted solutions (0.25-0.5%) to avoid corneal damage. |
| Patient Advice | Do not take this medication by mouth unless specifically prescribed for a deficiency. Topical use only for skin or eye conditions as directed. · Avoid contact with eyes unless using ophthalmic solution. In case of accidental eye exposure, flush with water for 15 minutes. · If using for Wilson disease, follow the prescribed chelating agent regimen strictly; do not substitute with cupric sulfate. · Report any signs of copper toxicity: metallic taste, nausea, vomiting, diarrhea, abdominal pain, or jaundice. · Store out of reach of children. Ingestion can cause severe poisoning. |