What is the treatment for copper deficiency (hypocupremia) replacement?

From the Guidelines

For copper deficiency replacement, the recommended treatment is copper administration, typically in the form of oral, enteral, or IV routes, with a dosage of 4-8 mg/day, as indicated by the most recent guideline 1. The choice of route will be determined by the severity of the copper deficit. Treatment of deficiency usually will require provision of copper 4-8 mg/day.

Key Considerations

• Copper may be delivered by the oral, enteral, or IV routes 1.
• With blood concentrations <12 mmol/L and high CRP >20 mg/L, a deficiency is likely and copper administration can be considered 1.
• With values < 8 mmol/L with or without elevated CRP, repletion should be indicated 1.
• The standard dosage is based on the most recent espen micronutrient guideline, which recommends 4-8 mg/day for copper replacement 1.

Monitoring and Adjustments

• Monitor serum copper and ceruloplasmin levels every 4-6 weeks during treatment.
• Severe deficiency may require intravenous copper administration under medical supervision.
• Most patients see improvement within 4-6 weeks of starting supplementation.
• Continue treatment until blood levels normalize and symptoms resolve, then consider maintenance therapy or dietary adjustments to prevent recurrence.

Important Interactions

• Avoid taking zinc supplements at the same time, as zinc can interfere with copper absorption 1.
• Maintain a ratio of 8- to 15-mg zinc to 1-mg copper when giving additional zinc and copper, and close monitoring is required if higher zinc or copper doses are indicated because each affects the absorption of the other 1.

From the FDA Drug Label

Copper 0.4 mg/mL (Cupric Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for TPN. Administration helps to maintain copper serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms. The treatment for copper deficiency (hypocupremia) replacement is copper supplementation via intravenous solutions, such as copper histidine (IV) or Cupric Chloride Injection, USP, as part of Total Parenteral Nutrition (TPN) to maintain copper serum levels and prevent deficiency symptoms 2.

From the Research

Treatment for Copper Deficiency

The treatment for copper deficiency (hypocupremia) replacement involves copper supplementation, which can be administered orally or intravenously.

• Copper deficiency anemia is treated with oral or intravenous copper replacement in the form of copper gluconate, copper sulfate, or copper chloride 3.
• Intravenous copper repletion can result in the rapid correction of hematologic indices, while combined intravenous and oral copper supplementation can normalize serum copper levels 4.
• The dosage for intravenous copper repletion can be 4-8 times the usual nutrition recommendations, especially in cases of severe copper deficiency due to reduced absorption after bariatric bypass surgery 5.
• Copper supplementation is essential in parenteral nutrition to prevent adverse effects of deficiency, with estimated requirements of 0.3 mg/day in adults and 20 microg/kg body weight/day in children and infants 6.

Administration and Effectiveness

• Oral copper supplements can be used for maintenance therapy, while intravenous copper supplements are often used for initial treatment or in cases of severe deficiency 3.
• Hematological manifestations of copper deficiency are fully reversible with copper supplementation over a 4- to 12-week period 3.
• Neurological manifestations, however, are only partially reversible with copper supplementation, highlighting the importance of early diagnosis and treatment 4, 3.