Recommended Dosage and Duration of Copper Supplementation for Treating Copper Deficiency
For treating copper deficiency, oral supplementation with 4-8 mg/day of elemental copper is recommended for mild to moderate deficiency, while intravenous copper may be required for severe deficiency. 1
Dosage Recommendations by Age and Route
Parenteral Nutrition Dosing
- Preterm infants: 40 μg/kg/day 2
- Term infants and children: 20 μg/kg/day (up to maximum 0.5 mg/day) 2
- Adults: 0.3-0.5 mg/day for routine supplementation 2
Oral Supplementation
- Mild to moderate deficiency: 4-8 mg/day of elemental copper 1
- Severe deficiency: May require intravenous supplementation 1, 3
Duration of Treatment
The duration of copper supplementation depends on several factors:
- Severity of deficiency: More severe deficiencies require longer treatment
- Underlying cause: Ongoing causes (e.g., malabsorptive conditions) may require lifelong supplementation
- Clinical response: Treatment should continue until:
Monitoring During Treatment
- Serum copper and ceruloplasmin levels: Should be monitored regularly, especially in patients on long-term parenteral nutrition 2
- Complete blood count: To assess improvement in anemia and neutropenia 5
- Functional assessment: Improvement in activities of daily living can be expected with 12 months of continued supplementation 4
Special Considerations
- High gastrointestinal fluid losses: Require higher copper intake (increased by 10-15 μg/kg) 2
- Zinc supplementation: Maintain a ratio of 8-15 mg zinc to 1 mg copper when supplementing both minerals 1
- Liver disease: Copper is primarily excreted through bile; dose adjustment may be needed in hepatic impairment 2
- Timing of intervention: Earlier treatment correlates with better functional outcomes 4
Formulations Available
- Copper sulfate: For adults and children ≥12 years: 10 drops 3-4 times daily; children 2-11 years: 5 drops 3-4 times daily 6
- Copper gluconate: For adults: four droppers full twice daily 7
Pitfalls and Caveats
- Neurological manifestations may only be partially reversible despite adequate supplementation 5
- Delayed diagnosis and treatment correlate with poorer outcomes 4
- Excessive zinc supplementation can induce copper deficiency by competing for absorption 1
- Regular monitoring is essential, particularly in high-risk patients (bariatric surgery, malabsorptive conditions, long-term parenteral nutrition) 1, 3