Wilson disease: Note: Dose expressed in mg elemental zinc:
Usual dosage: Oral: 50 mg 3 times daily. Note: In patients who are able to consistently separate administration from food and strictly adhere to the dosing schedule, may administer 25 mg 3 times daily or 50 mg twice daily (minimum effective dose: 75 mg/day in 2 or 3 divided doses); increase dose to 50 mg 3 times daily if inadequate response to lower dose (AASLD [Roberts 2008]; Brewer 1993; manufacturer's labeling).
Pregnant patients: Oral: 25 mg 3 times daily; may increase to 50 mg 3 times daily if inadequate response to lower dose.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Zinc acetate: Pediatric drug information")
Wilson disease: Note: Dose expressed in mg of elemental zinc:
Children ≥5 years to <10 years: Limited data available: Oral: 25 mg 3 times daily (AASLD [Roberts 2008])
Children ≥10 years and Adolescents: Oral: 25 to 50 mg 3 times daily (AASLD [Roberts 2008]; manufacturer's labeling)
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Galzin: 25 mg, 50 mg
Wilzin: 25 mg [contains brilliant blue fcf (fd&c blue #1), corn starch]
No
Strength of Galzin capsule is expressed as elemental zinc.
Oral: Administer on empty stomach at least 1 hour before or 2 to 3 hours after meals, and at least 1 hour separated from beverages other than water. Gastric irritation is most commonly associated with morning dose; may administer morning dose between breakfast and lunch if gastric irritation occurs. Swallow capsule whole; do not chew or open.
Oral: Administer on empty stomach at least 1 hour before or 2 to 3 hours after meals, and 1 hour away from beverages other than water. Gastric irritation most commonly associated with morning dose; may administer 1 hour after breakfast if gastric irritation occurs. Swallow capsule whole; do not chew or open.
Wilson disease: Maintenance treatment of Wilson disease following chelation therapy.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined:
Central nervous system: Neurological deterioration (uncommon)
Gastrointestinal: Gastric irritation, increased serum amylase, increased serum lipase
Hepatic: Increased serum alkaline phosphatase
<1%, postmarketing, and/or case reports: Hepatic insufficiency
Hypersensitivity to zinc acetate or any component of the formulation.
Concerns related to adverse effects:
• Central nervous system: Neurological deterioration may occur with initial therapy as copper stores are mobilized; effects are less common when compared to chelation therapy.
• GI effects: Gastric irritation/upset may occur with use and particularly with the morning dose.
Other warnings/precautions:
• Appropriate use: Not recommended for initial treatment of Wilson disease in symptomatic patients; may be used as maintenance therapy after patient has been stabilized on initial chelation therapy.
• Therapy management: Hepatic copper levels should not be used to manage therapy as they do not differentiate between potentially toxic free copper and safely bound copper.
None known.
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Cephalexin: Zinc Salts may decrease the absorption of Cephalexin. Management: Consider administering oral zinc salts at least 3 hours after cephalexin. Risk D: Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
Dolutegravir: Zinc Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral zinc salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral zinc salts. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Quinolones: Zinc Salts may decrease the serum concentration of Quinolones. Management: Give oral quinolones at several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for enox-, levo-, nor-, pe- or ofloxacin or nalidixic acid) oral zinc salts. Risk D: Consider therapy modification
Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Risk D: Consider therapy modification
Tetracyclines: Zinc Salts may decrease the absorption of Tetracyclines. Only a concern when both products are administered orally. Management: Separate administration of oral tetracycline derivatives and oral zinc salts by at least 2 hours to minimize this interaction. Risk D: Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Risk D: Consider therapy modification
Food and beverages other than water may interfere with zinc absorption. Management: Administer on empty stomach at least 1 hour before or 2 to 3 hours after meals and at least 1 hour separated from beverages other than water. Gastric irritation is most commonly associated with morning dose; may administer morning dose between breakfast and lunch if GI irritation occurs.
Menstrual irregularities and infertility are associated with Wilson disease. Patients treated for Wilson disease are able to conceive and therapy should be optimized prior to pregnancy (AASLD [Roberts 2008]).
Outcome data following maternal use of zinc acetate for the treatment of Wilson disease during pregnancy are available (Brewer 2000; Mussi 2021; Pfeiffenberger 2018). Continued treatment of Wilson disease during pregnancy improves pregnancy outcomes. Appropriate doses of zinc acetate can be maintained during pregnancy. Close monitoring is recommended (AASLD [Roberts 2008]; EASL 2012).
Zinc is present in breast milk.
Data related to the presence of zinc in breast milk are available from a patient receiving zinc acetate 25 mg 3 times daily throughout pregnancy and following delivery for the treatment of Wilson disease. Breast milk concentrations of zinc were 10.80 mcg/mL on postpartum day 4 and 3.28 mcg/mL on postpartum day 32. Maternal serum concentrations of zinc ranged from 0.73 mcg/mL (postpartum day 3) to 1.43 mcg/mL (postpartum day 32). Authors of the study also evaluated zinc concentrations in an infant formula, which were 4.5 mcg/mL. Maternal dietary intake of zinc was not evaluated (Isagawa 2020).
Additional data are available from a study of breastfeeding patients treated with zinc acetate for Wilson disease (n=6) and healthy controls (n=25). Treated patients received zinc 50 to 150 mg/day and were 15 to 118 days postpartum. Breast milk concentrations of zinc in treated patients ranged from 1.46 to 4.23 mcg/mL. In comparison, breast milk concentrations of zinc in healthy controls ranged from 0.29 to 4.62 mcg/mL. Copper concentrations were also evaluated. Breast milk concentrations of copper were 0.30 to 0.48 mcg/mL, and 0.06 to 0.60 mcg/mL in treated patients and healthy controls, respectively. Breast milk was also sampled in 1 patient 2 days after delivery treated with zinc 100 mg/day. Zinc concentrations in colostrum were 3.94 mcg/mL; copper concentrations were 0.53 mcg/mL. All mothers in this study were treated for Wilson disease prior to and during pregnancy as well as postpartum. All infants were breastfed and reported to have normal development (Kodama 2021).
Breastfeeding is not recommended by the manufacturer due to the possibility of zinc-induced copper deficiency in a breastfed infant.
Dietary reference intakes for elemental zinc:
≥19 years of age: 11 mg/day (men); 8 mg/day (women).
Pregnant patients: 11 mg/day.
Breastfeeding patients: 12 mg/day.
Serum non-ceruloplasmin bound copper, 24-hour urinary copper excretion, 24-hour urinary zinc level; LFTs, neurologic evaluation including speech
24-hour urinary copper excretion: ≤75 mcg/24 hours (AASLD [Roberts 2008]).
Non-ceruloplasmin plasma copper (free copper): <20 mcg/dL.
Zinc induces production of the copper binding protein metallothionein in enterocytes. Copper binding within enterocytes results in an impairment of the intestinal absorption of dietary copper and reabsorption of endogenously secreted copper in saliva, bile, gastric acid. Following enterocyte desquamation, bound copper is eliminated in the feces.
Absorption: Small intestine (IOM 2001); impaired with food and beverages (other than water).
Distribution: Stored primarily in skeletal muscle and bone (IOM 2001).
Protein binding: Albumin and alpha 1-macroglobulin (Foote 1984).
Excretion: Feces and urine (IOM 2001).
Capsules (Galzin Oral)
25 mg (per each): $2.28
50 mg (per each): $3.79
Capsules (Wilzin Oral)
25 mg (per each): $0.00
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