What is the recommended treatment for copper deficiency?

Treatment of Copper Deficiency

For mild copper deficiency, give two Forceval tablets daily (or equivalent multivitamin containing 1-2 mg copper) for 3 months and recheck levels; for severe copper deficiency, refer immediately to a specialist for consideration of intravenous copper replacement at doses 4-8 times the standard nutritional recommendations (4-8 mg/day). 1, 2

Severity-Based Treatment Algorithm

Mild Copper Deficiency

• Initiate oral supplementation with two Forceval tablets daily (or equivalent multivitamin providing 1-2 mg copper) 1
• Recheck copper and ceruloplasmin levels after 3 months of treatment 1
• Always check both zinc and copper levels simultaneously before starting replacement, as these minerals compete for absorption and zinc excess can precipitate or worsen copper deficiency 1

Severe Copper Deficiency

• Refer urgently to a specialist for assessment and consideration of intravenous copper replacement 1
• Intravenous copper doses of 4-8 mg/day are required for active repletion—substantially higher than standard nutritional supplementation 2, 3
• This aggressive approach is critical because severe deficiency causes potentially irreversible neurological complications (myeloneuropathy) that respond poorly even to adequate copper replacement 4, 2

Critical Monitoring Requirements

Zinc-Copper Balance

• Maintain a ratio of 8-15 mg zinc to 1 mg copper when supplementing either mineral 1
• Close monitoring is mandatory if higher doses of either zinc or copper are indicated, as each impairs absorption of the other 1
• High-dose zinc supplementation (>30 mg daily) can paradoxically cause copper deficiency and should be avoided or carefully monitored 3

Laboratory Follow-Up

• Measure serum copper, ceruloplasmin, and 24-hour urinary copper levels to confirm diagnosis 5
• Check C-reactive protein (CRP) to differentiate true copper deficiency from inflammatory conditions that can lower ceruloplasmin 5
• Hematologic abnormalities (anemia, neutropenia, leukopenia) typically resolve within 4-12 weeks of adequate copper supplementation 6

Common Clinical Pitfalls

Neurological Complications

• Copper deficiency myeloneuropathy is often unrecognized and can become irreversible if treatment is delayed 4, 2
• Neurological deficits show only partial resolution even with aggressive copper replacement, unlike hematologic abnormalities which fully reverse 4, 6
• Patients presenting with gait abnormalities, sensory changes, or spasticity combined with anemia should be evaluated urgently for copper deficiency 4, 2

High-Risk Populations Requiring Screening

• Post-bariatric surgery patients (especially Roux-en-Y gastric bypass) are at particularly high risk and should have copper levels checked every 6-12 months 3, 4, 2
• Patients on long-term parenteral nutrition require copper monitoring every 6-12 months 5
• Those taking zinc supplements, on prolonged tube feeding, or with malabsorptive conditions need regular copper assessment 2, 6

Specific Formulations and Dosing

Oral Copper Supplementation

• Copper sulfate, copper gluconate, or copper chloride can be used for oral replacement 6
• Standard nutritional supplementation: 1-3 mg/day 3
• Treatment doses for documented deficiency: 4-8 mg/day 3, 2
• FDA-approved copper sulfate dosing (ages 12+): 10 drops taken 3-4 times daily 7

When Oral Therapy Fails

• If copper levels do not improve after 3 months of oral supplementation, refer to specialist for assessment and consideration of intravenous copper injections 1
• Intravenous replacement is also indicated when severe neurological symptoms are present or when oral absorption is compromised 2