Tralement Trace Elements Injection 4 3 mg/mL; .3 mg/mL; 55 ug/mL; 60 ug/mL Injection, Solution, 25 vials
Other active recalls for Trace Elements Injection 4 (different manufacturers) — 1 · tap to view
🆔 Identity & classification
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🏷️ RxNorm drug class
This medicine belongs to the Antidotes class.
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🏭 Manufacturer & labeler
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🩺 Clinical
Patient education
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Ask a licensed pharmacist directly — free, answered by our team.
🧪 Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
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UNII 059QF0KO0R
Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.
1 inactive ingredient listed in the exact product block matched to this NDC.
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ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.Inactive ingredient FAQ
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💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per mL | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | $97.78 | $2,444.60 / 25 ml |
| Medicare drug plans payPart D · quarterly | No Part D plan price is available for this NDC in our data. | |
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🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Tralement 3 mg/mL; .3 mg/mL; 55 ug/mL; 60 ug/mLthis 00517-9305-25 | American | 25 vials | — | — | FDA listed | — |
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⏳ Availability & generic status
We did not find an FDA-approved generic match for this exact strength, form and route. Patent/protection dates below may affect future generic timing.
Why the date isn’t exact: Generic timing can change because patents may be challenged, settled, licensed, added, removed, or worked around with a narrower label — and FDA approval does not always mean a pharmacy can get the generic today.
🛈 What do these terms mean?
- Patent
- Legal protection listed in the Orange Book that may delay generic approval or launch. Issued by the U.S. Patent & Trademark Office.
- Substance patent
- Covers the active drug molecule itself — the hardest to design around. A generic generally can’t launch until it expires.
- Formulation (product) patent
- Covers a specific formulation or dosage form. A generic can sometimes work around it with a different formulation.
- Method-of-use patent
- A patent covering one specific approved use of the drug — not necessarily the whole molecule. A generic can sometimes launch with a “skinny label” that carves out the protected use and keeps the others.
- Skinny label
- A generic label that omits a still-patented use when the FDA allows it — letting a generic reach the market for the unprotected uses.
- Exclusivity
- FDA-granted marketing protection, separate from patents — e.g. 5-yr new chemical entity, 7-yr orphan drug, or a +6-month pediatric extension.
- Paragraph IV
- A generic applicant’s formal challenge to a listed patent. It can potentially lead to earlier generic entry, but often involves litigation or a settlement.
- RLD / RS
- Reference Listed Drug — the brand product the FDA uses as the reference for generic applications. Reference Standard — the product the FDA expects generics to compare against in bioequivalence testing.
- TE / AB rating
- FDA therapeutic-equivalence rating. An AB rating generally means the FDA considers a generic therapeutically equivalent to — and substitutable for — the brand.
- LOE (loss of exclusivity)
- The latest patent or exclusivity currently listed — the loss-of-exclusivity / latest-listed-protection date shown on this page. Paragraph-IV challenges and settlements can move the real date earlier; FDA approval and a manufacturer’s decision to market can move it later.
Built from the FDA Orange Book. The bars above are scaled to each protection’s expiry; the red LOE marker is the last one to lapse.
| Patent | Type | Use code | Expires |
|---|---|---|---|
| US 12150957 ↗ | Method of use | U-3900 | Jul 1, 2041 |
| US 12150957 ↗ | Method of use | U-3899 | Jul 1, 2041 |
| US 12150957 ↗ | Method of use | U-3899 | Jul 1, 2041 |
| US 12150956 ↗ | Method of use | U-3899 | Jul 1, 2041 |
| US 12150956 ↗ | Method of use | U-3899 | Jul 1, 2041 |
| US 12150956 ↗ | Method of use | U-3900 | Jul 1, 2041 |
| US 11975022 ↗ | Method of use | U-3899 | Jul 1, 2041 |
| US 11975022 ↗ | Method of use | U-3899 | Jul 1, 2041 |
| US 11975022 ↗ | Method of use | U-3900 | Jul 1, 2041 |
| US 11786548 ↗ | Drug product | — | Jul 1, 2041 |
| US 11998565 ↗ | Drug product | — | Jul 1, 2041 |
| US 11786548 ↗ | Drug product | — | Jul 1, 2041 |
| US 11998565 ↗ | Drug product | — | Jul 1, 2041 |
| US 11998565 ↗ | Drug product | — | Jul 1, 2041 |
| US 11786548 ↗ | Drug product | — | Jul 1, 2041 |
Is there a generic version of TRALEMENT VIAL?
The FDA approved a generic — why can’t I get it at my pharmacy yet?
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🗺️ Medicaid utilization & spend
📊 Medicare Part D spend CMS · PART D · 2025 (Q1-Q4)
🔬 Reported adverse events (FAERS)
Top reported reactions
Age at onset
Reporter sex
Serious outcomes
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📦 Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Status |
|---|---|---|---|
| 00517-9305-25 You're viewing this | 25 VIAL, SINGLE-DOSE in 1 TRAY (0517-9305-25) / 1 mL in 1 VIAL, SINGLE-DOSE (0517-9305-01) | 2020-09-29 | Active |
🧭 About this NDC listing & data coverage
What data is (and isn’t) available for this NDC — tap to expand
| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | ✓ Available |
| NADAC pharmacy acquisition price (CMS) | — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey. |
| Orange Book / therapeutic-equivalence data | ✓ Available |
| HCPCS J-code billing crosswalk | — Not published for this NDC Most self-administered / retail products have no J-code — that is normal. |
| Medicaid utilization (CMS SDUD) | ✓ Available |
Questions about this listing
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📄 Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Tralement ® is indicated in adult and pediatric patients weighing at least 10 kg as a source of zinc, copper, manganese, and selenium for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. Tralement is a combination of trace elements (zinc sulfate, cupric sulfate, manganese sulfate and selenious acid) indicated in adult and pediatric patients weighing at least 10 kg as a source of zinc, copper, manganese, and selenium for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated.
( 1 )
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION Single-dose vial amd multiple-dose vial . Not for direct intravenous infusion. ( 2.1 ) See full prescribing information for information on preparation, administration and general dosing considerations.
( 2.1 , 2.2 , 2.3 , 2.4) Recommended Dosage Each mL of Tralement provides zinc 3 mg, copper 0.3 mg, manganese 55 mcg, and selenium 60 mcg. ( 2.5 ) Adults and Pediatric Patients Weighing at Least 50 kg : The recommended dosage of Tralement is 1 mL per day added to parenteral nutrition. Tralement is not recommended for patients who may require a lower dosage of one or more of the individual trace elements.
( 2.5 ) Pediatric Patients Weighing 10 kg to 49 kg : The recommended dosage of Tralement based on body weight is 0.2 mL to 0.8 mL per day added to parenteral nutrition. Tralement does not provide the recommended daily dosage of zinc (in heavier patients in some weight bands), copper or selenium. Additional supplementation using single trace element products may be needed for these patients.
For complete dosing information see table in the full prescribing information. ( 2.4 , 2.5 ) Monitor trace element concentrations in blood during long-term administration of parenteral nutrition. ( 2.5 )
2.1Important Administration Information Tralement is supplied as a single-dose vial and multiple-dose vial for admixture use only. It is not for direct intravenous infusion . Prior to administration, Tralement must be transferred to a separate parenteral nutrition container and used as an admixture in parenteral nutrition solution.
The final parenteral nutrition solution is for intravenous infusion into a central or peripheral vein. The choice of a central or peripheral venous route should depend on the osmolarity of the final infusate. Solutions with osmolarity of 900 mOsmol/L or greater must be infused through a central catheter [ see Warnings and Precautions ( 5.2 )] .
2.2Preparation and Administration Instructions Tralement is not for direct intravenous infusion. Prior to administration, Tralement must be prepared and used as an admixture in parenteral nutrition solution. Add Tralement to the parenteral nutrition solution in a suitable work area such as a laminar flow hood (or an equivalent clean air compounding area).
The key factor in the preparation is careful aseptic technique to avoid inadvertent touch contamination during mixing of solutions and addition of other nutrients. Inspect the parenteral nutrition solution containing Tralement for particulate matter before admixing, after admixing, and prior to administration.
2.3Preparation Instructions for Admixing Using a Parenteral Nutrition Container Inspect Tralement single-dose vial and multiple-dose vial for particulate matter. Transfer Tralement to the parenteral nutrition container after the admixture of amino acids, dextrose, lipid emulsion (if added), and electrolytes solutions is prepared. Because additives may be incompatible, evaluate all additions to the parenteral nutrition container for compatibility and stability of the resulting preparation.
Consult with pharmacist, if available. For introducing additives to the parenteral nutrition container, use aseptic technique. An interaction may occur between cupric ion and ascorbic acid; therefore, multivitamin additives should be added to the admixed parenteral nutrition solution shortly before infusion.
Inspect the final parenteral nutrition solution containing Tralement to ensure that: o Precipitates have not formed during mixing or addition on additives. o The emulsion has not separated, if lipid emulsion has been added. Separation of the emulsion can be visibly identified by a yellowish streaking or the accumulation of yellowish droplets in the admixed emulsion. o Discard if any precipitates are observed. Stability and Storage Single-dose vial.
Discard unused portion. Multiple-dose vial: May puncture up to 20 times. Discard any unused portion after 28 days.
Use parenteral nutrition solutions con…
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Injection: Clear, colorless to slightly blue solution in a 1 mL single-dose vial and 10 mL multiple-dose vial. Each mL contains zinc 3 mg, copper 0.3 mg, manganese 55 mcg, and selenium 60 mcg. Injection: (3) 1 mL in a single-dose vial and 10 mL in a multiple-dose vial. Each mL contains zinc 3 mg, copper 0.3 mg, manganese 55 mcg, and selenium 60 mcg.
⛔ Contraindications ▾
4 CONTRAINDICATIONS Tralement is contraindicated in patients with hypersensitivity to zinc or copper [ see Warnings and Precautions ( 5.7 )]. Hypersensitivity to zinc or copper ( 4, 5.7 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Pulmonary Embolism due to Pulmonary Vascular Precipitates : If signs of pulmonary distress occur, stop the infusion and initiate a medical evaluation. (5.1) Vein Damage and Thrombosis : Solutions with osmolarity of 900 mOsmol/L or more must be infused through a central catheter. ( 2.1 , 5.2 ) Neurologic Toxicity with Manganese : Monitor for clinical signs and symptoms of neurotoxicity, whole blood manganese concentrations and liver function tests in patients receiving long-term Tralement.
Discontinue Tralement and consider brain magnetic resonance imaging (MRI) if toxicity suspected. ( 5. 3) Hepatic Accumulation of Copper and Manganese : Assess for development of hepatic or biliary dysfunction.
Monitor concentrations of copper and manganese in patients with cholestasis, biliary dysfunction or cirrhosis receiving Tralement long-term. ( 5.4 ) Aluminum Toxicity : Increased risk in patients with renal impairment, including preterm infants. ( 5.5 , 8.4 ) Monitoring and Laboratory Tests : Monitor blood zinc, copper, manganese, and selenium concentrations, fluid and electrolyte status, serum osmolarity, blood glucose, liver and kidney function, blood count and coagulation parameters.
( 5.6 , 2.4 ) Hypersensitivity Reactions with Zinc and Copper : If reactions occur, discontinue Tralement and initiate appropriate medical treatment. ( 5.7) To report SUSPECTED ADVERSE REACTIONS, contact American Regent, Inc. at 1-800-734-9236 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
5.1Pulmonary Embolism due to Pulmonary Vascular Precipitates Pulmonary vascular precipitates causing pulmonary vascular emboli and pulmonary distress have been reported in patients receiving parenteral nutrition. The cause of precipitate formation has not been determined in all cases; however, in some fatal cases, pulmonary emboli occurred as a result of calcium phosphate precipitates. Precipitation has occurred following passage through an in-line filter; in vivo precipitate formation may also have occurred.
If signs of pulmonary distress occur, stop the parenteral nutrition infusion and initiate a medical evaluation. In addition to inspection of the solution [ see Dosage and Administration (2.2, 2.3)] , the infusion set, and catheter should also periodically be checked for precipitates.
5.2Vein Damage and Thrombosis Tralement must be prepared and used as an admixture in parenteral nutrition solution. It is not for direct intravenous infusion. In addition, consider the osmolarity of the final parenteral nutrition solution in determining peripheral versus central administration.
Solution with an osmolarity of 900 mOsmol/L or greater must be infused through a central catheter [ see Dosage and Administration ( 2.1 )]. The infusion of hypertonic nutrient solution into a peripheral vein may result in vein irritation, vein damage, and/or thrombosis. The primary complication of peripheral access is venous thrombophlebitis, which manifests as pain, erythema, tenderness or a palpable cord.
Remove the catheter as soon as possible, if thrombophlebitis develops.
5.3Neurologic Toxicity with Manganese Manganese accumulation in the basal ganglia has been reported in adult and pediatric patients on long-term parenteral nutrition receiving manganese at higher than recommended dosages and in association with cholestatic liver disease. Some adult patients with brain MRI findings reportedly experienced neuropsychiatric symptoms, including changes in mood or memory, seizures and/or parkinsonian-like tremors, dysarthria, mask-face, and halting gait. Some pediatric patients experienced dystonic movements or seizures.
Brain MRI findings and clinical symptoms have also been observed in patients who received manganese at or below the recommended dosage and with normal blood manganese concentrations. Regression of symptoms and MRI findings have occurred over weeks to months following discontinuation of manganese in most patients but have not always completely re…
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following adverse reactions were identified in clinical studies or post-marketing reports. Given that some of these reactions were reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Adverse reactions with other components of parenteral nutrition solutions : • Pulmonary embolism due to pulmonary vascular precipitates [ see Warnings and Precautions ( 5.
1 )] • Vein damage and thrombosis [ see Warnings and Precautions ( 5.2 )] • Aluminum toxicity [see Warnings and Precautions ( 5.5 )] Adverse reactions with the use of trace elements administered parenterally or by other routes of administration : • Neurologic toxicity with manganese [see Warnings and Precautions ( 5.3 )] • Hepatic accumulation of copper and manganese [see Warnings and Precautions ( 5.4 )] • Hypersensitivity reactions with zinc and copper [ see Warnings and Precautions ( 5.7) ] No adverse reactions related to zinc, copper, selenium, or manganese have been reported in patients receiving intravenously administered parenteral solutions containing these trace elements within the recommended dosage range.
( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Actavis at 1-800-432-8534 or FDA at 1-800-FDA-1088, or www.fda.gov/medwatch.
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Pediatric Patients Weighing Less than 10 kg : Tralement is not approved for use in this subpopulation because the product does not provide an adequate dosage of zinc, copper, or selenium and exceeds the recommended dosage of manganese. ( 8.4 )
8.1Pregnancy Risk Summary Administration of the recommended dose of Tralement in parenteral nutrition is not expected to cause major birth defects, miscarriage, or adverse maternal or fetal outcomes. Deficiency of trace elements may result in adverse pregnancy and fetal outcomes (see Clinical Considerations). Animal reproduction studies have not been conducted with Tralement or with the individual trace elements.
The estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Clinical Considerations Disease-associated Maternal and/or Embryo-Fetal Risk Deficiencies of trace elements, including zinc, copper, manganese, and selenium are associated with adverse pregnancy and fetal outcomes. Pregnant women have an increased metabolic demand for trace elements. Parenteral nutrition with Tralement should be considered if a pregnant woman’s nutritional requirements cannot be fulfilled by oral or enteral intake.
8.2Lactation Risk Summary Zinc, copper, manganese, and selenium are present in human milk. Administration of the approved recommended dose of Tralement in parenteral nutrition is not expected to cause harm to a breastfed infant. There is no information on the effects of zinc sulfate, cupric sulfate, manganese sulfate, or selenious acid on milk production.
The developmental and health benefits of breastfeeding should be considered, along with the mother’s clinical need for Tralement and any potential adverse effects on the breastfed infant from Tralement or from the underlying maternal condition.
8.4Pediatric Use Tralement is approved for use in pediatric patients weighing at least 10 kg as a source of zinc, copper, manganese, and selenium for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. Safety and dosing recommendations in pediatric patients are based on published literature describing controlled studies of products containing zinc, copper, manganese, and selenium [see Dosage and Administration ( 2.2 )]. Tralement is not approved for use in pediatric patients weighing less than 10 kg because the product does not provide an adequate dosage of zinc, copper, or selenium to meet the needs of this subpopulation and exceeds the recommended dosage of manganese.
8.5Geriatric Use Reported clinical experience has not identified a difference in requirements for zinc, copper, manganese, or selenium between elderly and younger patients.
8.6Hepatic Impairment Copper is primarily excreted in the bile. Excretion is decreased in patients with cholestasis and/or cirrhosis. Manganese is found, and presumed to be excreted, in bile [see Clinical Pharmacology ( 12.3 )].
Hepatic accumulation of copper and manganese have been reported with long-term administration in parenteral nutrition at dosages higher than recommended [see Warnings and Precautions ( 5.4) ]. For patients with cholestasis, biliary dysfunction, or cirrhosis, monitor hepatic and biliary function during long-term administration of Tralement. If a patient develops signs or symptoms of hepatic or biliary dysfunction during use of Tralement, obtain serum concentrations of copper and ceruloplasmin as well as manganese whole blood concentrations.
Consider using individual trace element products in patients with hepatic and/or biliary dysfunction.
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Administration of the recommended dose of Tralement in parenteral nutrition is not expected to cause major birth defects, miscarriage, or adverse maternal or fetal outcomes. Deficiency of trace elements may result in adverse pregnancy and fetal outcomes (see Clinical Considerations). Animal reproduction studies have not been conducted with Tralement or with the individual trace elements.
The estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Clinical Considerations Disease-associated Maternal and/or Embryo-Fetal Risk Deficiencies of trace elements, including zinc, copper, manganese, and selenium are associated with adverse pregnancy and fetal outcomes. Pregnant women have an increased metabolic demand for trace elements. Parenteral nutrition with Tralement should be considered if a pregnant woman’s nutritional requirements cannot be fulfilled by oral or enteral intake.
🧒 Pediatric Use ▾
8.4Pediatric Use Tralement is approved for use in pediatric patients weighing at least 10 kg as a source of zinc, copper, manganese, and selenium for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. Safety and dosing recommendations in pediatric patients are based on published literature describing controlled studies of products containing zinc, copper, manganese, and selenium [see Dosage and Administration ( 2.2 )]. Tralement is not approved for use in pediatric patients weighing less than 10 kg because the product does not provide an adequate dosage of zinc, copper, or selenium to meet the needs of this subpopulation and exceeds the recommended dosage of manganese.
🧓 Geriatric Use ▾
8.5Geriatric Use Reported clinical experience has not identified a difference in requirements for zinc, copper, manganese, or selenium between elderly and younger patients.
🆘 Overdosage ▾
10 OVERDOSAGE There is no information on overdos Management of overdosage is supportive care based on presenting signs and symptoms. Obtain blood samples for laboratory testing of the individual trace elements and ceruloplasmin for copper. Zinc Acute zinc toxicity was reported in an infant who received an inadvertent 1,000-fold overdose of zinc in parenteral nutrition that led to cardiac failure and death.
Zinc toxicity in adult patients receiving 17 to 400-fold the recommended dosage in parenteral nutrition for 2.5 to 60 days reported signs and symptoms including vomiting, diarrhea, hyperamylasemia, thrombocytopenia, and anemia. The zinc serum concentration was 2 to 30-fold the upper end of the reported range in healthy subjects in these cases. Copper Acute copper toxicity was reported in patients with oral, intravenous, or subcutaneous administration.
Clinical manifestations included metallic taste, nausea, vomiting, abdominal pain, and multi-organ failure involving kidney, liver, blood, and cardiovascular systems. Chelating agents can be used for treatment of acute toxicity. Long-term administration of parenteral copper above recommended dosage may result in significant accumulation of copper in the liver, brain, and other tissues with possible organ damage [see Warnings and Precautions ( 5.4 ) ].
Manganese Acute manganese toxicity was reported in adult patients following infusion of manganese more than 10,000-fold the recommended dosage and after use of dialysis fluid contaminated with manganese. Signs and symptoms included skin flushing, acute pancreatitis, elevated whole blood manganese concentrations, and MRI evidence of brain accumulation of manganese. Chronic infusion and oral intake of manganese above recommended dosage have resulted in neuropsychiatric symptoms and MRI evidence of brain accumulation of manganese [see Warnings and Precautions ( 5.3 ) ].
Selenium Acute selenium toxicity was reported with oral overdosage of greater than 1 g/day. Symptoms included nausea, vomiting, diarrhea, abdominal pain, garlic breath odor, and altered mental status. Death from circulatory collapse was reported after oral ingestion of 5 to 10 g of selenium with blood concentrations ranging 10 to 50-fold the upper end of the reported range in healthy subjects.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Zinc Zinc functions as a cofactor of various enzymes including DNA polymerases, RNA polymerases, alcohol dehydrogenase, and alkaline phosphatases. Zinc is a coordinator of protein structural folding that interacts with a variety of proteins, lipids, and nucleic acids. In addition, zinc is a catalyst of essential biochemical reactions, including activation of substrates of carbonic anhydrase in erythrocyte.
Copper Copper is a cofactor for many metalloenzymes acting as an oxidase to achieve reduction of molecular oxygen. Examples of copper metalloenzymes include but are not limited to lysyl oxidase, monoamine oxidase, ferroxidase, cytochrome C oxidase, dopamine beta monooxygenase, tyrosinase, and superoxide dismutase.\ Manganese Manganese is essential for the normal catalytic activity of several metalloenzymes including manganese superoxide dismutase, arginase, glutamine synthetase, phosphoenolpyruvate decarboxylase, and pyruvate carboxylase.
Manganese contributes to the normal function of several other enzyme families including the oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. Selenium Selenious acid is converted in vivo to hydrogen selenide via glutathione-involved electron reductions. Hydrogen selenide acts as a selenium pool to form selenoproteins which include, but are not limited to, glutathione peroxidase, iodothyronine deiodinase, peroxidase, and thioredoxins.
12.2Pharmacodynamics The exposure-response relationship and the time course of pharmacodynamic response are unknown for zinc, copper, manganese, and selenium.
12.3Pharmacokinetics Zinc Over 85% of total body zinc is found in skeletal muscle and bone. In blood, zinc is mainly localized within erythrocytes. Approximately 80% of serum zinc is bound to albumin and the remainder to α-2-macroglobulin and amino acids.
In adults, zinc is primarily excreted via the gastrointestinal tract and eliminated in the feces. A smaller amount of zinc is excreted via the kidneys in the urine. Urinary zinc excretion rates in very low birth weight preterm infants are relatively high in the neonatal period, and they decline to a level on a body weight basis that is similar to that of normal adults by two months of age.
Copper In plasma, about 7% of copper is bound to albumin and amino acids. In the liver, about 93% of copper is bound to ceruloplasmin and released to the serum. Copper is excreted in bile and into the gastrointestinal tract where it is not reabsorbed.
Copper is also eliminated through the kidneys. Manganese Manganese is widely distributed in body tissues including liver and specific brain regions such as the basal ganglia. The concentrations of manganese are higher in erythrocytes compared to the plasma or serum concentrations.
In human plasma, manganese is bound to albumin and β1-globulin. Manganese is found in human bile suggesting biliary excretion. Selenium In humans, 85% of intravenous administered 75Se was protein-bound within 4 to 6 hours and 95% by 24 hours.
🧬 Mechanism of Action ▾
12.1Mechanism of Action Zinc Zinc functions as a cofactor of various enzymes including DNA polymerases, RNA polymerases, alcohol dehydrogenase, and alkaline phosphatases. Zinc is a coordinator of protein structural folding that interacts with a variety of proteins, lipids, and nucleic acids. In addition, zinc is a catalyst of essential biochemical reactions, including activation of substrates of carbonic anhydrase in erythrocyte.
Copper Copper is a cofactor for many metalloenzymes acting as an oxidase to achieve reduction of molecular oxygen. Examples of copper metalloenzymes include but are not limited to lysyl oxidase, monoamine oxidase, ferroxidase, cytochrome C oxidase, dopamine beta monooxygenase, tyrosinase, and superoxide dismutase.\ Manganese Manganese is essential for the normal catalytic activity of several metalloenzymes including manganese superoxide dismutase, arginase, glutamine synthetase, phosphoenolpyruvate decarboxylase, and pyruvate carboxylase.
Manganese contributes to the normal function of several other enzyme families including the oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. Selenium Selenious acid is converted in vivo to hydrogen selenide via glutathione-involved electron reductions. Hydrogen selenide acts as a selenium pool to form selenoproteins which include, but are not limited to, glutathione peroxidase, iodothyronine deiodinase, peroxidase, and thioredoxins.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED Tralement (trace elements injection 4*, USP) is a clear, colorless to slightly blue solution supplied as follows: NDC 0517-9305-01 1 mL single-dose vial NDC 0517-9305-25 Packaged in trays containing 25 vials per tray *Each mL of Tralement contains zinc 3 mg, copper 0.3 mg, manganese 55 mcg, and selenium 60 mcg. Vial closure is not made with natural rubber latex. Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [See USP Controlled Room Temperature].
Store admixed solution at 2ºC to 8ºC (36ºF to 46ºF) [see Dosage and Administration ( 2.3 )].
📋 Description ▾
11 DESCRIPTION Tralement ® (trace elements injection 4*, USP) is a sterile, non-pyrogenic, clear, and colorless to slightly blue solution, intended for use as a combination of four trace elements and an additive to intravenous solutions for parenteral nutrition. It contains no preservative. Each single-dose vial contains 1 mL and each multiple-dose vial contains 10 mL. *Each mL contains zinc 3 mg (equivalent to zinc sulfate 7.41 mg), copper 0.3 mg (equivalent to cupric sulfate 0.75 mg), manganese 55 mcg (equivalent to manganese sulfate 151 mcg), selenium 60 mcg (equivalent to selenious acid 98 mcg), and water for injection.
Sulfuric acid may be added to adjust pH between 1.5 and 3.5. Zinc sulfate exists as a heptahydrate. The structural formula is: Molecular formula: ZnSO 4 • 7H 2 O.
Molecular weight: 287.54 g/mol. Cupric sulfate exists as a pentahydrate. The structural formula is: Molecular formula: CuSO 4 • 5H 2 O.
Molecular weight: 249.69 g/mol. Manganese sulfate exists as a monohydrate. The structural formula is: Molecular formula: MnSO 4 • H 2 O.
Molecular weight: 169.02 g/mol. The structural formula of selenious acid is: Molecular formula: H 2 SeO 3 . Molecular weight: 128.97 g/mol.
Tralement contains no more than 6,000 mcg/L of aluminum. Zinc Sulfate Structural Formula Cupric Sulfate Structural Formula Manganese Structural Formula Selenious Acid Structural Formula
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Inform patients, caregivers, and home healthcare providers of the following risks of Tralement: • Pulmonary embolism due to pulmonary vascular precipitates [ see Warnings and Precautions ( 5.1 )] • Vein damage and thrombosis [ see Warnings and Precautions ( 5.2) ] • Neurologic toxicity with manganese [see Warnings and Precautions ( 5.3) ] • Hepatic accumulation of copper and manganese [ see Warnings and Precautions ( 5.4 )] • Aluminum toxicity [see Warnings and Precautions ( 5.5) ] • Hypersensitivity reactions with zinc and copper [see Warnings and Precautions ( 5.7 )