Copper Sulphate

Usage

Copper sulphate is primarily prescribed for the treatment and prevention of copper deficiency. It is also used in some regions for the treatment of phosphorus burns. While it has been used historically for other conditions like Alzheimer’s disease, acne, and tooth plaque, robust scientific evidence does not support these uses. It is important to note that copper sulphate ingestion can be toxic in high doses.

• Pharmacological classification: Copper sulphate is classified as a mineral supplement.

• Mechanism of Action: Copper is an essential trace element vital for various physiological functions, including:

  • Erythropoiesis and leukopoiesis
  • Bone mineralization
  • Elastin and collagen cross-linking
  • Oxidative phosphorylation
  • Catecholamine metabolism
  • Melanin formation
  • Antioxidant protection

Alternate Names

• Cupric sulfate
• Blue vitriol
• Roman vitriol
• Salzburg vitriol

Brand names vary depending on the manufacturer and country.

How It Works

• Pharmacodynamics: Copper is a cofactor for numerous enzymes involved in critical metabolic processes, including energy production, iron metabolism, and neurotransmitter synthesis. It plays a vital role in the formation of connective tissues, red blood cells, and melanin.

• Pharmacokinetics:

  • Absorption: Copper is absorbed primarily in the stomach and small intestine. Dietary factors like phytate, zinc, iron, molybdenum, calcium, and phosphorus can inhibit absorption, while proteins and organic acids can enhance it.
  • Metabolism: Absorbed copper is transported to the liver bound to albumin and incorporated into ceruloplasmin, the major copper-carrying protein in blood. Excess copper is excreted primarily in bile.
  • Elimination: The primary route of elimination is through bile into the feces. A small amount is also excreted in urine.

• Mode of Action: Copper acts as a catalyst in various enzymatic reactions. For example, in the formation of red blood cells, it is part of the enzyme ceruloplasmin which helps convert ferrous iron to ferric iron, a crucial step in the synthesis of hemoglobin. Copper also aids bone mineralization, collagen and elastin cross-linking, and the crosslinking of keratin precursors.

• Receptor binding, enzyme inhibition, or neurotransmitter modulation: Copper acts primarily as an enzyme cofactor rather than by direct receptor binding or neurotransmitter modulation.

• Elimination pathways: Primarily biliary excretion, with minimal urinary excretion.

Dosage

Dosage depends on the purpose (treatment or prevention of deficiency), age, and individual patient needs.

Standard Dosage

Adults:

• Recommended Dietary Allowance (RDA): 900 mcg/day.
• Maximum daily intake: 10 mg/day.

Children:

• RDA varies by age:
  • Birth to 6 months: 200 mcg/day
  • 7-12 months: 220 mcg/day
  • 1-3 years: 340 mcg/day
  • 4-8 years: 440 mcg/day
  • 9-13 years: 700 mcg/day
  • 14-18 years: 890 mcg/day

Special Cases:

• Elderly Patients: Dosage adjustments are not typically necessary unless underlying renal or hepatic impairment exists.
• Patients with Renal Impairment: Dose reduction may be necessary depending on the degree of impairment.
• Patients with Hepatic Dysfunction: Copper can accumulate in patients with hepatic disease, so dose adjustment is necessary.
• Patients with Comorbid Conditions: Copper supplementation should be carefully monitored in patients with Wilson’s disease or other conditions affecting copper metabolism.

Clinical Use Cases

The use of copper sulphate in the clinical settings described below (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) pertains specifically to intravenous administration as part of total parenteral nutrition (TPN) to prevent copper deficiency in patients who cannot obtain adequate amounts through oral intake.

• TPN (Adults): 0.5-1.5 mg/day of elemental copper, added to TPN.
• TPN (Children): 20 mcg elemental copper/kg/day IV. May be added to TPN.

Side Effects

Common Side Effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Metallic taste

Rare but Serious Side Effects

• Kidney failure
• Liver damage
• Hemolytic anemia
• Jaundice

Adverse Drug Reactions (ADR)

• Severe gastrointestinal effects, including bloody diarrhea
• Fever
• Low blood pressure
• Anemia
• Heart problems

Contraindications

• Wilson’s disease
• Known hypersensitivity to copper sulphate
• Severe renal impairment
• Obstructive biliary disease

Drug Interactions

• Antacids: Reduce copper absorption.
• Zinc supplements: Interfere with copper absorption.
• Iron supplements: Can reduce copper absorption.
• Penicillamine: Chelates copper and increases its excretion.
• Trientine: Chelates copper and increases its excretion.
• Ascorbic acid (high doses): Reduces copper absorption.
• Medications for birth control: Can increase copper levels in the blood.

Pregnancy and Breastfeeding

• Pregnancy Safety Category: A (adequate, well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus).
• RDA during pregnancy: 1000 mcg/day.
• RDA during breastfeeding: 1300 mcg/day.
• Excessive copper intake during pregnancy should be avoided.

Drug Profile Summary

• Mechanism of Action: Essential trace element acting as cofactor for various enzymes.
• Side Effects: Nausea, vomiting, diarrhea, abdominal pain, metallic taste (common). Kidney and liver damage, hemolytic anemia (rare but serious).
• Contraindications: Wilson’s disease, copper hypersensitivity, severe renal impairment, obstructive biliary disease.
• Drug Interactions: Antacids, zinc, iron supplements, penicillamine, trientine, high-dose ascorbic acid, medications for birth control.
• Pregnancy & Breastfeeding: Generally safe at recommended doses.
• Dosage: Adults: 900 mcg/day (RDA), up to 10 mg/day. Pediatric doses vary by age.
• Monitoring Parameters: Serum copper levels.

Popular Combinations

Copper is often included in multivitamin and mineral supplements. Specific therapeutic combinations outside of multivitamins are less common, though some formulations for osteoporosis combine copper with zinc, manganese, and calcium.

Precautions

• Monitor for signs of copper toxicity.
• Assess liver and kidney function in patients receiving long-term supplementation.
• Avoid exceeding the maximum daily intake.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Copper Sulphate?

A: The RDA for adults is 900 mcg/day, with a maximum safe intake of 10 mg/day. Pediatric dosages vary by age, ranging from 200 mcg/day for infants to 890 mcg/day for adolescents.

Q2: How is copper sulphate administered?

A: Copper supplementation is typically administered orally. Intravenous administration is reserved for specific clinical situations like patients receiving TPN.

Q3: What are the signs of copper toxicity?

A: Nausea, vomiting, abdominal pain, metallic taste, jaundice, dark urine, and in severe cases, kidney and liver damage, hemolytic anemia, and neurological symptoms.

Q4: Can copper sulphate be taken during pregnancy?

A: Yes, copper sulphate is considered safe during pregnancy when taken within the recommended dosage guidelines (1000 mcg/day).

Q5: What foods are rich in copper?

A: Liver, shellfish, nuts, seeds, legumes, cocoa products, and whole grains are good sources of dietary copper.

Q6: How does copper interact with zinc?

A: Zinc and copper compete for absorption in the intestines. High doses of zinc can interfere with copper absorption and potentially lead to copper deficiency.

Q7: What is the role of copper in the body?

A: Copper is a cofactor for numerous enzymes involved in energy production, iron metabolism, connective tissue formation, nerve function, and immune system function.

Q8: How is copper deficiency diagnosed?

A: Diagnosis involves blood tests to measure serum copper and ceruloplasmin levels.

Q9: What is Wilson’s disease?

A: Wilson’s disease is a rare genetic disorder characterized by excessive accumulation of copper in the liver, brain, and other organs. Copper supplementation is contraindicated in individuals with this condition.