Syprine (trientine hydrochloride)
An approved treatment for Wilson Disease.
Drug facts
The same compound appears under different names depending on the context. Here is how to identify Trientine hydrochloride wherever you encounter it, plus the key facts at a glance.
- Generic name
- Trientine hydrochloride
- Brand name
- Syprine
- Drug class
- Copper chelator (oral)
- Manufacturer
- Bausch Health (Syprine); generic available
- How it's taken
- Syprine comes as 250mg capsules, and generic capsules are approved in 250mg and 500mg strengths.
Trientine hydrochloride (Syprine and generics) is a capsule taken by mouth that removes excess copper from the body in people with Wilson disease who cannot tolerate penicillamine[1].
- The FDA approved Syprine in November 1985 and the first generic version in February 2018[3][4].
- Adults usually start at 750-1,250mg a day split into 2 to 4 doses, taken on an empty stomach[1].
- In 2 studies of 41 penicillamine-intolerant patients aged 6 to 54, 34 improved on trientine hydrochloride[1].
- The Syprine label says clinical experience is limited, and the capsules are stored in the refrigerator[1].
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Where Trientine hydrochloride fits
Syprine's FDA label covers people with Wilson disease who cannot tolerate penicillamine[1].
- Cuvrior's label says Cuvrior is not substitutable milligram for milligram with other trientine products[2].
- Cuvrior is approved for a different group: adults with stable Wilson disease who are already de-coppered and tolerate penicillamine[2].
- Syprine is stored in the refrigerator, while Cuvrior is stored at room temperature[1][2].
How Trientine hydrochloride works
In Wilson disease, the body cannot get rid of copper properly, so copper builds up in the liver and then spreads to other organs[1]. Trientine hydrochloride is a chelator, a drug that binds tightly to metals, and it binds excess copper so the body can pass it out in urine[1]. Trientine and iron block each other's absorption, and the label notes that iron deficiency can develop during treatment[1].
Side effects and safety
Clinical experience with Syprine is limited, and the label says patients should stay under regular medical supervision throughout treatment[1]. In the clinical studies, the reported side effects were iron deficiency and a return of lupus in 1 patient who had first developed it on penicillamine[1]. Reports after approval include dystonia (abnormal muscle contractions), muscle spasms and myasthenia gravis, a disorder causing muscle weakness[1].
The label advises close monitoring for iron deficiency anemia, especially in women[1]. The label asks patients to take their temperature nightly for the first month and report any fever or skin rash[1]. Capsule contents can irritate the skin, so the label says to wash any exposed skin with water promptly[1]. In a 2023 study of 115 people whose Wilson disease had neurologic or mixed features, neurologic symptoms worsened within the first 3 months of treatment in 30 (26%); this was not seen in people with liver-only or no symptoms[5].
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Trientine hydrochloride
Syprine comes as 250mg capsules, and generic capsules are approved in 250mg and 500mg strengths[1][4]. The label says the capsules are swallowed whole with water, not opened or chewed[1]. The usual starting dose is 750-1,250mg a day for adults and 500-750mg a day for children, divided into 2 to 4 doses[1]. The maximum is 2,000mg a day for adults and 1,500mg a day for children 12 and under[1].
Each dose is taken on an empty stomach, at least 1 hour before or 2 hours after meals and at least 1 hour apart from other drugs, food or milk[1]. The label says the dose is raised only if the response is not adequate or free copper in the blood stays above 20mcg/dL[1]. Doctors review the long-term dose every 6-12 months using blood copper tests and 24-hour urine copper collections[1].
If iron is needed, the label says to separate iron and trientine by at least 2 hours[1]. Capsules are kept in the refrigerator at 2-8°C (36-46°F)[1].
Availability and cost
Generic versions may be available at a lower cost. Ask your pharmacist.
Help paying for Syprine
The maker of Syprine publishes no copay card; the offers below are what its official pages list. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE, but charity funds often can. None of the 2 charity funds for Wilson Disease were open on October 26, 2026. Without insurance, you can apply to the drugmaker's free medicine program, which sets its own eligibility rules. Pick your insurance below to see which offers fit you.
- Free medicine program
Brand SYPRINE is on the Bausch Health PAP list. Free medicine for eligible patients with limited or no coverage, shipped to your home at no cost for up to 12 months. Requirements include being a legal US resident and outpatient with a valid prescription, and household income at or below 300% of the Federal Poverty Level. Applicants must lack coverage or have exhausted appeals through government programs. If you appear eligible for Medicare Part D Low-Income Subsidy, you must apply for it first. Some forms or strengths may not be covered.
For: no insurance, underinsured, Medicaid · source
Good to know: Applies to brand SYPRINE only; generic trientine is made by many companies and is not covered. Phone hours are Monday to Friday, 8 AM to 8 PM ET. A WD Rx Access copay form exists, but its posted terms expired, so current copay help is unconfirmed.
Charity funds for Wilson Disease
- From a charity · Wilson Disease AssociationWDA Patient Assistance fundApply directly
Pays for: Travel and lodging (up to 7 days) for testing or treatment, for the patient and one companion, up to $2,000 per year.
The foundation says: “Status not shown on page”
How Wilson disease treatments compare
Four FDA-approved medications are available for Wilson disease, plus investigational programs at different stages. Treatment choice depends on your stage (active de-coppering versus stable maintenance), your tolerance to penicillamine, whether you have neurologic or hepatic features, and your age. This chart summarizes the practical differences between the approved options.
Wilson Disease has 4 FDA-approved treatments: Cuprimine / Depen (penicillamine, approved 1970); Syprine (trientine hydrochloride, approved 1985); Galzin (zinc acetate, approved 1997); Cuvrior (trientine tetrahydrochloride, approved 2022). Cuprimine / Depen is typically used as approved for wilson disease in general. carries a boxed warning and needs frequent blood and urine tests, twice a week in the first month on the cuprimine label..
| Drug | How it works | How it’s given | How often | Where you take it | Typical use | FDA approved |
|---|---|---|---|---|---|---|
Cuprimine / Depen penicillamine | Copper chelator that binds copper in the body so it leaves in the urine. The original Wilson disease drug. | Oral capsule or tablet, taken on an empty stomach | 1,000 to 1,500mg a day in 2 to 4 doses to start, 750 to 1,000mg for maintenance (AASLD) | Home (oral) | Approved for Wilson disease in general. Carries a boxed warning and needs frequent blood and urine tests, twice a week in the first month on the Cuprimine label. | 1970 |
Syprine trientine hydrochloride You are here | Copper chelator that binds copper so it leaves in the urine. No trial has compared it head to head with penicillamine as a first treatment (AASLD). | Oral capsule, taken on an empty stomach (capsules require refrigeration) | 2 to 4 times daily | Home (oral) | Approved for patients who cannot tolerate penicillamine. Generic versions are available. | 1985 |
Galzin zinc acetate | Copper absorption blocker. It makes gut cells produce a protein (metallothionein) that traps copper from food before it can be absorbed. | Oral capsule, taken on an empty stomach | 3 times daily | Home (oral) | Approved for maintenance after a person has first been treated with a chelator; not for the first treatment of someone with symptoms. | 1997 |
Cuvrior trientine tetrahydrochloride | Copper chelator with the same action as Syprine, in a more stable salt that is stored at room temperature and taken twice a day. | Oral tablet, taken on an empty stomach | Twice daily | Home (oral) | Approved for adults with stable Wilson disease who are de-coppered and tolerant to penicillamine; designed as a maintenance switch option. | 2022 |
This chart summarizes approved Wilson disease treatments to help you understand your options. It is not medical advice. Treatment decisions depend on your individual disease stage, prior therapies, tolerability, and lab values for copper control. Investigational programs (ALXN1840, UX701, PM577a) are not included because they are not FDA-approved. Always discuss options with your hepatologist or metabolic specialist.
Clinical trial results
The Syprine label describes 2 studies in 41 patients aged 6 to 54 with Wilson disease who could not tolerate penicillamine[1]. Doses ranged from 450-2,400mg a day, and the average dose needed for the best response ranged from 1,000 to 2,000mg a day[1]. Over an average of 48.7 months of treatment, 34 of 41 patients improved and 4 had no change[1].
Of the rest, 2 were lost to follow-up and 1 got worse[1]. One investigator also looked back at 13 trientine-treated patients and 12 patients who had stopped all copper-removing treatment[1]. All 13 trientine patients were alive at the data cutoff, while 9 of the 12 untreated patients had died of liver disease[1].
Development history
The FDA approved Syprine (trientine hydrochloride) on November 8, 1985, for people with Wilson disease who cannot tolerate penicillamine[3][1]. Bausch Health now distributes Syprine in the US[1]. Teva's Watson Laboratories received the first generic approval for trientine hydrochloride on February 7, 2018[4]. More than 10 other generic versions were approved between 2019 and 2022, according to FDA records[4].
Orphalan's Cuvrior uses a different salt called trientine tetrahydrochloride and was approved on April 28, 2022[4]. Cuvrior is approved for a different group: adults with stable Wilson disease who are de-coppered and tolerate penicillamine[2].
Explore Wilson Disease trials
Other Wilson Disease treatments
Common questions about Trientine hydrochloride
▸What is Trientine hydrochloride (Syprine)?
Trientine hydrochloride (Syprine and generics) is a capsule taken by mouth that removes excess copper from the body in people with Wilson disease who cannot tolerate penicillamine[1]. The FDA approved Syprine in November 1985 and the first generic version in February 2018[3][4]. Adults usually start at 750-1,250mg a day split into 2 to 4 doses, taken on an empty stomach[1]. In 2 studies of 41 penicillamine-intolerant patients aged 6 to 54, 34 improved on trientine hydrochloride[1]. The Syprine label says clinical experience is limited, and the capsules are stored in the refrigerator[1].
▸How does Trientine hydrochloride work?
In Wilson disease, the body cannot get rid of copper properly, so copper builds up in the liver and then spreads to other organs[1]. Trientine hydrochloride is a chelator, a drug that binds tightly to metals, and it binds excess copper so the body can pass it out in urine[1]. Trientine and iron block each other's absorption, and the label notes that iron deficiency can develop during treatment[1].
▸What are the side effects of Trientine hydrochloride?
Clinical experience with Syprine is limited, and the label says patients should stay under regular medical supervision throughout treatment[1]. In the clinical studies, the reported side effects were iron deficiency and a return of lupus in 1 patient who had first developed it on penicillamine[1]. Reports after approval include dystonia (abnormal muscle contractions), muscle spasms and myasthenia gravis, a disorder causing muscle weakness[1]. The label advises close monitoring for iron deficiency anemia, especially in women[1]. The label asks patients to take their temperature nightly for the first month and report any fever or skin rash[1]. Capsule contents can irritate the skin, so the label says to wash any exposed skin with water promptly[1]. In a 2023 study of 115 people whose Wilson disease had neurologic or mixed features, neurologic symptoms worsened within the first 3 months of treatment in 30 (26%); this was not seen in people with liver-only or no symptoms[5].
▸How is Trientine hydrochloride taken?
Syprine comes as 250mg capsules, and generic capsules are approved in 250mg and 500mg strengths[1][4]. The label says the capsules are swallowed whole with water, not opened or chewed[1]. The usual starting dose is 750-1,250mg a day for adults and 500-750mg a day for children, divided into 2 to 4 doses[1]. The maximum is 2,000mg a day for adults and 1,500mg a day for children 12 and under[1]. Each dose is taken on an empty stomach, at least 1 hour before or 2 hours after meals and at least 1 hour apart from other drugs, food or milk[1]. The label says the dose is raised only if the response is not adequate or free copper in the blood stays above 20mcg/dL[1]. Doctors review the long-term dose every 6-12 months using blood copper tests and 24-hour urine copper collections[1]. If iron is needed, the label says to separate iron and trientine by at least 2 hours[1]. Capsules are kept in the refrigerator at 2-8°C (36-46°F)[1].
▸Is Trientine hydrochloride FDA approved?
Yes, Trientine hydrochloride (Syprine) is FDA approved (1985) for the treatment of Wilson Disease.
▸What is trientine hydrochloride (Syprine) used for?
Trientine hydrochloride (Syprine) is a copper chelator taken by mouth for Wilson disease[1].
Who it is for: Its FDA label covers people with Wilson disease who cannot tolerate penicillamine[1].
Approval history: Syprine was approved in the US on November 8, 1985[3]. Generic versions have been approved since February 7, 2018[4].
Source: FDA label, Syprine (DailyMed); Drugs@FDA, Syprine; FDA Drugs@FDA records (openFDA), trientine
▸How is trientine hydrochloride taken?
The label says trientine hydrochloride capsules are taken by mouth, swallowed whole, on an empty stomach[1].
Timing: The label lists at least 1 hour before or 2 hours after meals, and at least 1 hour apart from other drugs, food, or milk[1].
Starting dose: The usual starting dose is 750 to 1,250mg a day for adults and 500 to 750mg a day for children, divided into 2 to 4 doses[1].
Maximum and storage: The maximum is 2,000mg a day for adults and 1,500mg a day for children 12 and under[1]. The label says the capsules are kept in the refrigerator[1].
Source: FDA label, Syprine (DailyMed)
▸What are the side effects of trientine hydrochloride?
The label lists several side effects, and neurologic symptoms can worsen after starting treatment in some people.
Clinical studies: In clinical studies, the label lists iron deficiency and a return of lupus in 1 patient who had first developed it on penicillamine[1].
After approval: Reports after approval include dystonia, muscle spasms and myasthenia gravis[1].
Neurologic worsening: In a 2023 study of 115 people with neurologic or mixed Wilson disease, symptoms worsened within the first 3 months of treatment in 30 (26%)[5].
Source: FDA label, Syprine (DailyMed); Mohr et al., J Hepatol 2023
▸What is the difference between Syprine and Cuvrior?
Syprine and Cuvrior are both trientine products for Wilson disease, but they are approved for different patients and cannot be swapped dose for dose.
Syprine: Syprine (trientine hydrochloride) is approved for Wilson disease patients who cannot tolerate penicillamine[1].
Cuvrior: Cuvrior (trientine tetrahydrochloride, approved in 2022) is approved for adults with stable Wilson disease who are already de-coppered and tolerate penicillamine[4][2].
Dosing differences: Cuvrior's label says it is not substitutable milligram for milligram with other trientine products[2]. Syprine is stored in the refrigerator and taken in 2 to 4 daily doses, while Cuvrior is stored at room temperature and taken twice daily[1][2].
Source: FDA label, Syprine (DailyMed); FDA Drugs@FDA records (openFDA), trientine; FDA label, Cuvrior (DailyMed)
Sources and references
Every factual claim on this page is drawn from the public sources listed below. Click any reference to open the original document.
- Bausch Health / U.S. National Library of Medicine (DailyMed) · 2020-12. SYPRINE (trientine hydrochloride) capsules, Prescribing Information. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c34f77a7-996b-4470-b5df-d946a7fe5dbe
- Orphalan / U.S. National Library of Medicine (DailyMed) · 2025-06. CUVRIOR (trientine tetrahydrochloride) tablets, Prescribing Information. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f73feeae-62ad-401e-b9f7-5cb269127750
- U.S. Food and Drug Administration · 1985-11-08. SYPRINE (trientine hydrochloride), NDA 019194. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=019194
- U.S. Food and Drug Administration (openFDA) · 2026-11. Drugs@FDA application records for trientine products. https://api.fda.gov/drug/drugsfda.json?search=products.active_ingredients.name:TRIENTINE&limit=50
- Journal of Hepatology · 2023. Neurological worsening after initiation of treatment in Wilson disease (Mohr et al.). https://pubmed.ncbi.nlm.nih.gov/37116715/