Penicillamine is the drug of choice for treatment for Wilson's disease. However, the drug produces undesirable effects (see above) and some patients become intolerant. For these individuals, trientine (triethylenetetramine dihydrochloride) is an acceptable alternative. Trientine is an effective cupruretic agent (although possibly less potent than penicillamine) that is effective orally. Maximal daily doses of 2 g for adults or 1.5 g for children are taken in 2-4 divided portions on an empty stomach. Trientine may cause iron deficiency; this can be overcome with short courses of iron therapy, but iron and trientine should not be ingested within 2 hours of each other.
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