Overdose of Copper in details
Copper toxicity can produce prostration, behavior change, diarrhea, progressive marasmus, hypotonia, photophobia and peripheral edema. Such symptoms have been reported with a serum Copper level of 286 mcg/dl. Copper toxicity can also result in hemolysis and liver toxicity, including hepatic necrosis which may be fatal. D-penicillamine has been reported effective as an antidote.
Copper warnings
Direct intramuscular or intravenous injection of Copper 0.4 mg/mL (Copper Injection, USP) is contraindicated, as the acidic pH of the solution (2) may cause considerable tissue irritation.
Liver and/or biliary tract dysfunction may require omission or reduction of Copper and manganese doses because these elements are primarily eliminated in the bile.
WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.
Copper precautions
General
Do not use unless the solution is clear and the seal is intact.
Administration of zinc in the absence of Copper may cause a decrease in serum Copper levels.
Copper 0.4 mg/mL (Copper Injection, USP) should only be used in conjunction with a pharmacy directed admixture program using aseptic technique in a laminar flow environment; it should be used promptly and in a single operation without any repeated penetrations. Solution contains no preservatives; discard unused portion immediately after admixture procedure is completed.
It is not recommended to administer Copper to a patient with Wilson’s Disease, a genetic disease of Copper metabolism.
Drug Interactions
Cupric ion may degrade ascorbic acid in total parenteral nutrition (TPN) solutions. In order to avoid this loss of ascorbate, multivitamin additives should be added to TPN solutions immediately prior to infusion. Alternatively, the multivitamin additive may be added to one container of TPN solution, followed by Copper in a subsequent container.
Laboratory Tests
Twice monthly serum assays for Copper and/or ceruloplasmin are suggested for monitoring Copper concentrations in long-term TPN patients. As ceruloplasmin is a cuproenzyme, ceruloplasmin assays may be depressed secondary to Copper deficiency.
Carcinogenesis, Mutagenesis, and Impairment of Fertility
Long-term animal studies to evaluate the carcinogenic potential of Copper 0.4 mg/mL (Copper Injection, USP) have not been performed, nor have studies been done to assess mutagenesis or impairment of fertility.
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 Copper 0.4 mg/mL (Copper Injection, USP) is administered to a nursing woman.
Pediatric Use
There are limited data in infants weighing less than 1500 grams.
Pregnancy Category C.
Animal reproduction studies have not been conducted with Copper. It is also not known whether Copper can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Copper should be given to a pregnant woman only if clearly indicated.
Geriatric Use
An evaluation of current literature revealed no clinical experience identifying differences in response between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
References
- DailyMed. "COPPER: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DrugBank. "Copper". http://www.drugbank.ca/drugs/DB09130 (accessed September 17, 2018).
- MeSH. "Trace Elements". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
