What is Trilawil?

Trilawil is a prescription medication containing trientine tetrahydrochloride, a copper chelating agent used to treat Wilson's disease. Trilawil works by binding to excess copper in the body and promoting its elimination through urine, helping to prevent the toxic accumulation of copper in vital organs such as the liver, brain, and eyes.

Wilson's disease is a rare genetic disorder that causes copper to accumulate in the body, particularly in the liver and brain. Without proper treatment, this copper buildup can lead to life-threatening liver damage, neurological problems, and psychiatric symptoms.

Understanding Wilson's Disease

What is Wilson's Disease?

Wilson's disease is an inherited disorder of copper metabolism caused by mutations in the ATP7B gene. This gene produces a protein responsible for removing excess copper from the liver into bile for elimination from the body. When this protein is deficient or non-functional, copper accumulates in the liver and eventually spreads to other organs, particularly the brain and corneas of the eyes.

Prevalence and Genetics:

• Affects approximately 1 in 30,000 people worldwide
• Autosomal recessive inheritance - both parents must carry a mutation
• Carrier frequency approximately 1 in 90 people
• Over 500 different mutations identified in the ATP7B gene
• Can affect any ethnic group, though some populations have higher rates

Symptoms and Disease Manifestations:

Wilson's disease typically presents between ages 5 and 35, though it can occur at any age. Symptoms vary widely depending on which organs are affected:

Hepatic (Liver) Manifestations:

• Elevated liver enzymes (often the first sign)
• Fatty liver disease
• Acute hepatitis
• Chronic hepatitis
• Cirrhosis
• Acute liver failure

Neurological Manifestations:

• Tremors (especially "wing-beating" tremor)
• Dystonia (involuntary muscle contractions)
• Difficulty speaking (dysarthria)
• Difficulty swallowing (dysphagia)
• Coordination problems (ataxia)
• Parkinsonian symptoms

Psychiatric Manifestations:

• Depression
• Anxiety
• Personality changes
• Psychosis
• Cognitive impairment

Ophthalmologic Manifestations:

• Kayser-Fleischer rings (golden-brown rings around the cornea, highly characteristic of Wilson's disease)
• Sunflower cataracts

Other Manifestations:

• Hemolytic anemia
• Kidney problems
• Bone and joint problems
• Heart problems (rare)

Diagnosis:

• Low serum ceruloplasmin (copper-carrying protein)
• Elevated 24-hour urinary copper excretion
• Elevated hepatic copper content on liver biopsy
• Kayser-Fleischer rings on slit-lamp examination
• Genetic testing for ATP7B mutations

How Trilawil Works - Copper Chelation Mechanism

Mechanism of Action: Trientine as a Copper Chelator

Trilawil contains trientine tetrahydrochloride, which belongs to a class of medications called copper chelators. The term "chelation" comes from the Greek word for "claw," referring to how these molecules bind to metal ions.

How Trientine Works:

• Trientine forms stable complexes with copper ions in the body
• These copper-trientine complexes are water-soluble and can be eliminated through the kidneys
• By promoting urinary excretion of copper, trientine reduces the body's total copper burden
• Trientine may also reduce copper absorption from the gastrointestinal tract
• Over time, this leads to decreased copper accumulation in organs and gradual mobilization of stored copper

Trientine vs. Other Copper Chelators:

The two main copper chelators used in Wilson's disease are:

• D-Penicillamine - First-line chelator for many years, but associated with significant side effects including hypersensitivity reactions, bone marrow suppression, kidney problems, and paradoxical neurological worsening in some patients
• Trientine (Trilawil) - Alternative chelator with generally better tolerability profile, often used when patients cannot tolerate penicillamine or as initial therapy, particularly in patients with neurological symptoms

Zinc Therapy:

Zinc salts work differently than chelators - they block copper absorption from the intestines and are often used for maintenance therapy after initial chelation, or in presymptomatic patients.

Clinical Efficacy and Studies

FDA Approval and Clinical Development

Trientine hydrochloride was first approved by the U.S. FDA as an alternative copper chelating agent for Wilson's disease in patients intolerant to D-penicillamine. Trilawil contains the advanced formulation trientine tetrahydrochloride (TETA-4HCl), which was developed to address stability and adherence challenges of earlier trientine formulations. TETA-4HCl has received regulatory approval and has an orphan drug designation given the rare nature of Wilson's disease (affecting approximately 1 in 30,000 people worldwide).

Clinical Evidence:

• Trientine tetrahydrochloride is clinically proven to reduce copper levels through a dual mechanism — systemic chelation via urinary excretion and enhanced metallothionein synthesis reducing intestinal copper absorption. The Phase III CHELATE trial (Lancet Gastroenterology and Hepatology, 2022) enrolled 53 adult subjects with clinically stable Wilson disease (Leipzig score ≥4) and demonstrated that more patients on trientine tetrahydrochloride achieved the pre-specified composite endpoint of non-ceruloplasmin-bound copper and 24-hour urinary copper excretion within therapeutic target ranges. Improvements in liver function tests (ALT, AST, bilirubin) and neurological symptoms were also observed.
• Clinical studies demonstrate that continuous trientine therapy produces long-term remission in Wilson disease patients intolerant to D-penicillamine. Long-term outcomes include prevention of liver transplantation, stabilisation or improvement of neurological symptoms, and maintenance of safe copper levels. Trilawil begins lowering copper levels within weeks, with noticeable clinical improvements typically seen after several months of continuous therapy as body copper gradually normalises.
• The CHELATE phase III trial (Schilsky et al., Lancet Gastroenterol Hepatol, 2022) directly compared trientine tetrahydrochloride versus penicillamine for maintenance therapy in Wilson disease. Trientine tetrahydrochloride demonstrated non-inferiority to penicillamine in maintaining copper control, while offering a significantly better tolerability profile. D-penicillamine carries a conditional boxed warning due to serious adverse reactions, with up to 30% of patients experiencing adverse events necessitating discontinuation. In contrast, trientine is nonimmunogenic with a better overall safety profile.
• Trilawil (trientine tetrahydrochloride) has a well-established superior safety profile compared to D-penicillamine. It is nonimmunogenic, with fewer allergic and dermatological reactions, lower risk of bone marrow suppression, reduced nephrotoxicity, and a lower likelihood of causing paradoxical neurological worsening at treatment initiation. Most common adverse reactions (>5%) are abdominal pain, change of bowel habits, rash, alopecia, and mood swings — generally mild and manageable.
• Key published references: (1) Schilsky et al. Trientine tetrahydrochloride versus penicillamine for maintenance therapy in Wilson disease (CHELATE): a randomised, open-label, non-inferiority, phase 3 trial. Lancet Gastroenterol Hepatol 2022. https://doi.org/10.1016/S2468-1253(22)00270-9 | (2) Woimant et al. Efficacy and Safety of Two Salts of Trientine in the Treatment of Wilson's Disease. J. Clin. Med. 2022, 11, 3975. | (3) Kamlin et al. Trientine Tetrahydrochloride, From Bench to Bedside: A Narrative Review. Drugs (2024) 84:1509–1518. | (4) Weiss et al. Comparison of the Pharmacokinetic Profiles of Trientine Tetrahydrochloride and Trientine Dihydrochloride in Healthy Subjects. Eur J Drug Metab Pharmacokinet. 2021 Sep;46(5):665-675.

Trientine tetrahydrochloride versus penicillamine for maintenance therapy in Wilson disease (CHELATE): a randomised, open-label, non-inferiority, phase 3 trial.

Background: Wilson disease is an inherited disorder of copper transport. Whereas penicillamine is used therapeutically to re-establish copper balance, trientine is indicated for patients with penicillamine intolerance. We aimed to compare penicillamine with trientine tetrahydrochloride (TETA4) for maintenance therapy in patients with Wilson disease.

Methods: A randomised, open-label, non-inferiority, phase 3 trial at 15 health-care centres across nine countries (patients were recruited from 13 of these health-care centres across Brazil, Europe, and the USA). Enrolled patients aged 18-75 years with stable Wilson disease who were treated for at least 1 year with penicillamine. Patients entered a 12-week period to determine stability through clinical assessment by site investigators and predefined thresholds for serum non-caeruloplasmin-bound copper (NCC; by an exchangeable copper assay; 25-150 μg/L), 24 h urinary copper excretion (100-900 μg/24 h), and alanine aminotransferase (ALT; <2 × upper limit of normal).

Stable patients were randomly assigned (1:1) to continue receiving the maintenance twice daily dose of oral penicillamine or switched mg-for-mg to oral TETA4 centrally with a web-based system using minimisation. The primary endpoint, assessed 24 weeks after randomisation, was NCC by speciation assay.

The non-inferiority margin of mean difference in NCC by speciation assay was -50 μg/L, as estimated by a general linear model for repeated visits, adjusted for baseline values. Further data on safety and efficacy were collected during a 24-week extension period.

Findings:

• Between June 4, 2018, and March 10, 2020, 77 patients were screened. 53 patients were randomly assigned (27 to the penicillamine group and 26 to the TETA4 group).
• After 24 weeks, the mean difference in serum NCC by speciation assay between the penicillamine group and TETA4 group was -9·1 μg/L (95% CI -24·2 to 6·1), with the lower limit of the 95% CI within the defined non-inferiority margin. At 24 weeks, urinary copper excretion was lower with TETA4 than with penicillamine (mean difference 237·5 μg/24 h (99% CI 115·6 to 359·4).
• At 48 weeks, TETA4 remained non-inferior to penicillamine in terms of NCC by speciation assay (mean difference NCC -15·5 μg/L [95% CI -34·5 to 3·6]). Urinary copper excretion at 48 weeks remained in the expected range for well treated patients in both study groups, and the mean difference (124·8 μg/24 h [99% CI -37·6 to 287·1]) was not significantly different.
• At 24 weeks and 48 weeks, masked clinical adjudication of stability assessed by three independent clinicians confirmed clinical stability (100%) of all participants, in agreement with the stability seen with the NCC by speciation assay.
• There were no notable changes in either the Clinical Global Impression of Change or Unified Wilson Disease Rating Scale (neurological assessment) from baseline (pre-randomisation) at weeks 24 and 48.
• The mean change in serum total copper from baseline to 24 weeks was 17·6 μg/L (99% CI -9·5 to 44·7) with penicillamine and -6·3 μg/L (-34·7 to 22·1) with TETA4, and the mean change in serum total caeruloplasmin from baseline to 24 weeks was 1·8 mg/L (-19·2 to 22·8) with penicillamine and -2·2 mg/L (-6·1 to 1·7) with TETA4.

Safety:

• All liver enzymes were similar at 24 weeks and 48 weeks, with the exception of elevated ALT concentration at 48 weeks for patients in the TETA4 group.
• Penicillamine was associated with three post-randomisation serious adverse events (leukopenia, cholangiocarcinoma, and hepatocellular cancer); none were reported for TETA4.
• The most common treatment-emergent adverse events were headache for penicillamine (five [19%] of 27 patients vs two [8%] of 26) and abdominal pain for TETA4 (one [4%] vs four [15%]); all treatment-emergent adverse events resolved and were mild to moderate. One patient developed a rash with TETA4 that resolved on discontinuation of therapy.

Conclusion: The efficacy of TETA4 as oral maintenance therapy was non-inferior to penicillamine and well tolerated in adults with Wilson disease.

Experience on switching trientine formulations in Wilson disease: Efficacy and safety after initiation of TETA 4HCl as substitute for TETA 2HCl

Background and aim: This retrospective, multicenter study aims to assess the efficacy and safety in Wilson disease (WD) patients treated with trientine tetrahydrochloride (TETA 4HCl) after switch from trientine dihydrochloride (TETA 2HCl).

Methods: In total, 68 WD patients with stable copper metabolism were identified to receive TETA 4HCl (Cuprior™) after previous treatment with TETA 2HCl. We analyzed biochemical markers such as urinary copper, serum copper, non-coeruloplasmin bound copper (NCC), and transaminases as well as clinical scores (APRI; FIB-4 score) at baseline with a follow-up (FU) of 12 months. Safety of TETA 4HCl treatment was based on reported adverse events (AEs).

Results: The study cohort reflects a common WD cohort with a mean age of 20.3 years at diagnosis and 38.3 years at baseline. There are no significant differences concerning serum copper, NCC, transaminases, APRI, and FIB-4 score in the 3-month FU. Six-month FU revealed a decreased AST (P = 0.008), APRI (P = 0.042), and FIB-4 score (P = 0.039). GGT varied only borderline significantly in the 3-month, but not in the 6-month FU. Comparison of urinary copper within the subsets did not reveal a difference to baseline in all FUs, suggesting stable control of copper metabolism. Few AEs during TETA 4HCl treatment were reported, most commonly gastrointestinal discomfort. Only three treatments with TETA 4HCl were discontinued.

Conclusion: Copper parameters and liver function were stable after treatment switch to TETA 4HCl. Treatment with TETA 4HCl was generally well tolerated. This study indicates that the switch from TETA 2HCl to TETA 4HCl is safe and viable.

Dosing and Administration

Dosing Guidelines

Standard dosing is 20 mg/kg/day in 2–3 divided doses (maximum 2 g/day). Specific dosing by age group: Adults (≥13 years): 750 to 1,250 mg of Trientine Tetrahydrochloride orally, in divided doses given 2, 3, or 4 times daily; maximum dose 2,000 mg/day. Children (≤12 years): 500 to 750 mg orally in divided doses given 2, 3, or 4 times daily; maximum dose 1,500 mg/day. All doses should be administered 1 hour before or 2 hours after meals for optimal absorption. Doses should be adjusted based on urinary copper excretion and clinical response; lower maintenance doses may be used after initial de-coppering.

Available Strengths:

• Trientine Tetrahydrochloride 333 mg hard capsules — available in bottles of 100 capsules (MRP: ₹18,749 per bottle, as of November 2025). For purchase, call Laurus Rare Diseases at 7337585050.

Administration Instructions:

• Take on an empty stomach — at least 1 hour before or 2 hours after meals
• Separate from mineral supplements (iron, zinc, calcium) by at least 2 hours
• Swallow whole with water; do not crush or chew
• Typically divided into 2–4 doses per day
• If a dose is missed, take as soon as remembered unless it's almost time for the next dose

Dose Adjustments:

• Based on urinary copper excretion and clinical response
• Lower doses may be used for maintenance after initial treatment
• Special populations: Pregnancy — Trilawil should be used during pregnancy only if clearly needed and under close medical supervision. Wilson's disease must not go untreated during pregnancy as uncontrolled copper accumulation poses serious risks; trientine and zinc are considered safer options than penicillamine. Breastfeeding — it is not known whether trientine passes into breast milk; consult your physician before use. Paediatrics — Trilawil is approved for children under medical supervision with weight-based dosing (see above). Renal impairment — use with caution; monitor renal function regularly as trientine is excreted via the kidneys.

Safety Profile and Side Effects

Common Side Effects:

• Nausea (most common)
• Stomach upset or pain
• Heartburn
• Loss of appetite
• Headache
• Dizziness

Serious but Rare Side Effects:

• Iron deficiency anemia (trientine can chelate iron)
• Allergic reactions (rare)
• Lupus-like syndrome (very rare)
• Myasthenia gravis (extremely rare)

Advantages Over Penicillamine:

• Lower risk of hypersensitivity reactions
• Less likely to cause bone marrow suppression
• Less likely to cause paradoxical neurological worsening
• Generally better tolerated overall

Precautions and Contraindications:

Hypersensitivity reactions, characterized by rash, have been reported with the use of trientine. If a hypersensitivity reaction such as rash occurs, discontinuation should be considered.

• Monitor for iron deficiency; supplement if needed
• Use caution in patients with existing iron deficiency
• Trilawil should not be used in patients with known hypersensitivity to trientine or any component of the formulation. It should be used with caution in patients with pre-existing iron deficiency (trientine can chelate iron in addition to copper). Do not administer concomitantly with iron or zinc supplements, antacids containing aluminium or magnesium, or other copper-chelating agents unless specifically directed by a specialist.

Serious Warnings

• Potential for Worsening of Clinical Symptoms at Initiation of Therapy: May include neurological deterioration. Adjust dosage or discontinue Trilawil if clinical condition worsens.
• Copper Deficiency: Periodic monitoring is required.
• Iron Deficiency: If iron deficiency develops, a short course of iron supplementation may be given.
• Hypersensitivity Reactions: If rash or other hypersensitivity reaction occurs, consider discontinuing.

Drug Interactions

Avoid concomitant administration with:

• Iron or zinc supplements (take at least 2 hours apart)
• Antacids containing aluminium or magnesium
• Other copper-chelating agents, unless prescribed by a specialist
• Food, as it decreases absorption of trientine

Precautions and Contraindications:

Trilawil should not be used in patients with known hypersensitivity to trientine. Use with caution in pre-existing iron deficiency. Do not administer concomitantly with iron/zinc supplements, antacids containing aluminium or magnesium, or other copper-chelating agents unless directed by a specialist.

Monitoring and Laboratory Testing

Required Monitoring Parameters:

• 24-hour urinary copper excretion - Primary measure of treatment response; goal is typically 200-500 mcg/24 hours during initial therapy
• Serum ceruloplasmin - Should remain low but stable
• Free (non-ceruloplasmin) copper - Important indicator of treatment adequacy
• Liver function tests - ALT, AST, bilirubin, albumin, PT/INR
• Complete blood count - Monitor for iron deficiency anemia
• Iron studies - Serum iron, ferritin, transferrin saturation
• Neurological examination - Regular assessment of tremor, coordination, speech, swallowing
• Ophthalmological examination - Slit-lamp exam for Kayser-Fleischer rings
• Psychiatric assessment - Monitor mood, behavior, cognition

Monitoring Frequency:

• Initial treatment: Every 2-4 weeks until stabilized
• Maintenance: Every 3-6 months
• More frequent if complications or poor adherence

Treatment Options for Wilson's Disease

Comprehensive Treatment Approach:

Wilson's disease requires lifelong treatment. The main therapeutic strategies include:

1. Copper Chelators (Remove excess copper):

• Trientine (Trilawil) - Indicated for the treatment of Wilson's disease in adults, adolescents and children ≥ 5 years intolerant to D-penicillamine therapy; better safety profile
• D-Penicillamine - Historically first-line but higher side effect rate; may worsen neurological symptoms initially
• Tetrathiomolybdate - Investigational agent, may have advantages for neurological disease

2. Zinc Salts (Block copper absorption):

• Zinc acetate or zinc sulfate
• Used for maintenance therapy or presymptomatic patients
• Can be combined with chelators
• Slower onset of action than chelators

3. Liver Transplantation:

• Reserved for acute liver failure or decompensated cirrhosis not responding to medical therapy
• Curative for hepatic manifestations
• May improve neurological symptoms over time

4. Dietary Modifications:

• Avoid copper-rich foods (shellfish, nuts, chocolate, mushrooms, liver)
• Check copper content of drinking water
• Use water filters if necessary

Treatment Selection Guidelines:

• Neurological presentation: Trientine often preferred (lower risk of worsening)
• Hepatic presentation: Either chelator acceptable; trientine if better tolerability desired
• Presymptomatic: Zinc or trientine
• Maintenance after initial treatment: Lower-dose trientine or zinc
• Pregnancy: Continue treatment with dose reduction; trientine and zinc considered safer than penicillamine

For Healthcare Professionals

Diagnosis and Treatment Initiation:

• Confirm diagnosis with appropriate testing (ceruloplasmin, 24-hour urine copper, genetic testing)
• Assess disease severity and organ involvement
• Screen first-degree relatives
• Establish baseline laboratory values
• Educate patient on lifelong treatment necessity

Managing Treatment Challenges:

• Poor adherence — Most common cause of treatment failure; use pill organizers, reminders, address barriers
• Neurological worsening — Can occur with any chelator; may need dose adjustment or switching
• Side effects — Take with small amount of food if GI upset, switch chelators if necessary
• Iron deficiency — Supplement iron separately from trientine doses

Resources for Prescribers:

• Full prescribing information: www.laurusrarediseases.com/trilawil-healthcare.html
• EMA Product Information (Cuprior): www.ema.europa.eu — Cuprior EPAR Product Information
• Wilson's disease treatment guidelines (Journal of Hepatology 2024): journal-of-hepatology.eu
• Schilsky ML et al. Trientine tetrahydrochloride versus penicillamine for maintenance therapy in Wilson disease (CHELATE): a randomised, open-label, non-inferiority, phase 3 trial. Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1092-1102.
• Mohr I et al. Experience on switching trientine formulations in Wilson disease: Efficacy and safety after initiation of TETA 4HCl as substitute for TETA 2HCl. J Gastroenterol Hepatol. 2023 Feb;38(2):219-224.
• Medical information / expert consultation: Contact Laurus Rare Diseases at 7337585050

For Patients and Caregivers

Living with Wilson's Disease:

• Understanding the importance of lifelong treatment
• What happens if treatment is stopped (risk of severe relapse)
• How to recognize signs of disease worsening
• When to contact your healthcare provider

Taking Trilawil Effectively:

• Setting a daily routine (alarms, pill boxes)
• Taking on empty stomach - timing with meals
• Separating from vitamins and minerals
• What to do if you miss doses
• Managing side effects

Dietary Considerations:

• Foods to avoid or limit (high-copper foods)
• Reading nutrition labels
• Working with a dietitian
• Maintaining good nutrition despite restrictions

Quality of Life:

• Managing neurological symptoms (tremor, coordination)
• Physical therapy and occupational therapy
• Speech therapy if needed
• Mental health support
• School and work accommodations
• Family planning considerations

Patient Support and Resources

Financial Assistance:

• Laurus Rare Diseases patient assistance: For information on pricing, availability, and affordability support for Trilawil (Trientine Tetrahydrochloride 333 mg capsules), contact Laurus Rare Diseases directly at customer care number 7337585050 or visit www.laurusrarediseases.com/trilawil-healthcare.html
• Co-pay and affordability support: Patients are encouraged to speak with their treating physician or hospital pharmacist about available support schemes. Government-run rare disease programs and insurance schemes such as CGHS and state health missions in India may cover treatment costs for eligible patients with Wilson's disease.
• Insurance and reimbursement support: Patients can seek guidance on insurance navigation through their hospital's medical social work department or rare disease advocacy groups such as the Organisation for Rare Diseases India (ORDI) at www.ordi.in, which provides support for navigating insurance and financial assistance for rare disease treatments.
• Free or subsidised drug programs: Patients with Wilson's disease may be eligible for support under national rare disease policies. Consult your treating physician or contact Laurus Rare Diseases at 7337585050 to enquire about available compassionate use or patient support programs.

Patient Advocacy Organizations:

• Wilson Disease Association
• National Organization for Rare Disorders (NORD)
• Genetic and Rare Diseases Information Center (GARD)
• American Liver Foundation

Educational Materials:

• Patient guide downloads: Detailed guides on Wilson's disease, copper chelation therapy, dietary management, and living with Wilson's disease are available through the Wilson Disease Association at www.wilsonsdisease.org and NORD at www.rarediseases.org. Product information for Trilawil is also available at www.laurusrarediseases.com/trilawil-healthcare.html
• Video education series: Educational videos on Wilson's disease, copper metabolism, and patient journeys are available on the Wilson Disease Association YouTube channel and through NORD's rare disease video library at www.rarediseases.org
• Dietary guides and recipes: Low-copper diet guides and food lists are available through the Wilson Disease Association at www.wilsonsdisease.org. Key foods to avoid include shellfish, nuts, chocolate, mushrooms, and organ meats. Patients are encouraged to work with a registered metabolic dietitian to maintain balanced nutrition while limiting copper intake.
• Webinars and support groups: The Wilson Disease Association hosts patient webinars, annual family conferences, and peer support groups. Visit www.wilsonsdisease.org/events for upcoming events. In India, ORDI (www.ordi.in) and Global Genes (www.globalgenes.org) also host rare disease patient education and community support events.

Frequently Asked Questions (FAQ)

References and Scientific Literature

1. Schilsky ML, Czlonkowska A, Zuin M, Cassiman D, et al. Trientine tetrahydrochloride versus penicillamine for maintenance therapy in Wilson disease (CHELATE): a randomised, open-label, non-inferiority, phase 3 trial. Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1092-1102. doi:10.1016/S2468-1253(22)00270-9
2. Woimant F, et al. Efficacy and Safety of Two Salts of Trientine in the Treatment of Wilson's Disease. J. Clin. Med. 2022, 11, 3975.
3. Mohr I, Bourhis H, Woimant F, Obadia MA, et al. Experience on switching trientine formulations in Wilson disease: Efficacy and safety after initiation of TETA 4HCl as substitute for TETA 2HCl. J Gastroenterol Hepatol. 2023 Feb;38(2):219-224.
4. Kamlin COF, et al. Trientine Tetrahydrochloride, From Bench to Bedside: A Narrative Review. Drugs. 2024;84:1509–1518.
5. Weiss KH, et al. Comparison of the Pharmacokinetic Profiles of Trientine Tetrahydrochloride and Trientine Dihydrochloride in Healthy Subjects. Eur J Drug Metab Pharmacokinet. 2021 Sep;46(5):665-675.
6. European Medicines Agency. Cuprior (trientine tetrahydrochloride) — Summary of Product Characteristics. EMA Product Information
7. European Association for the Study of the Liver (EASL). Clinical Practice Guidelines for Wilson's Disease. Journal of Hepatology. 2024. journal-of-hepatology.eu