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Tralement

trace elements
Used for Nutritional Deficiency
Used for Nutritional Deficiency

Tralement and Multrys are nutrition supplements that contain four trace elements: zinc, copper, manganese, and selenium. These trace elements are essential for your body to work properly. Tralement (trace elements) is given to adults and children who need parenteral nutrition and can't get nourishment from food. It's usually added into the nutrition mixture, which is then given as an injection through the vein. At usual doses, side effects aren't common. But side effects are possible if the blood level of a trace element is too high, so your provider will monitor your blood levels and adjust the dose as needed.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Kristianne Hannemann, PharmD
Last reviewed on November 26, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsReferencesPricesMedicare
basics-icon

What is Tralement (trace elements)?

What is Tralement (trace elements) used for?

How Tralement (trace elements) works

Tralement (trace elements) provides your body with zinc, copper, manganese, and selenium. They're nutrients that your body needs to function properly.

  • Zinc can help boost your immune system, heal wounds, make proteins and genetic material in your cells, and support growth and development.

  • Copper is important for your cells to make energy, strengthen your body's tissues and blood vessels, and maintain a healthy nervous system and immune system.

  • Manganese helps protect your cells from damage. It also plays a role in bone, reproductive system, and immune system health.

  • Selenium is essential for reproduction and thyroid gland function. It also protects your cells from damage.

Drug Facts

Common BrandsTralement, Multrys
Drug ClassNutrition supplement
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Avg retail price
$7915.90(save 91.30%)
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$688.71
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What are the side effects of Tralement (trace elements)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

See Risks and Warnings.

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Toxicity from having too much trace elements in the body: fever, skin flushing, nausea, diarrhea, stomach pain, tremors (shaking), movement problems, changes in mood or memory, confusion, seizures
  • Serious allergic reaction: hives, rash, itching, dizziness, trouble breathing, chest pain, swelling

Source: DailyMed

pros-and-cons

Pros and cons of Tralement (trace elements)

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Pros

Provides four important trace elements in one medication

Good option for adults and children who can't eat or drink by mouth

Well tolerated when taking the recommended dose

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Cons

Only given to people receiving IV nutrition

Must be injected into the veins (after it's mixed with a nutrition solution)

Contains aluminum, which can be dangerous for people with kidney problems or babies who were born early

pharmacist-tips

Pharmacist tips for Tralement (trace elements)

pharmacist

  • Your provider will order your parenteral nutrition bags that have Tralement (trace elements) at a dose that's safe for you. Talk to your provider if you have questions about what dose of Tralement (trace elements) you should receive.

    • Don't take any other products containing zinc, copper, manganese, or selenium (like other multivitamins or supplements) unless your provider said it's okay. Doing so can cause your levels of these trace elements to be too high and raise your risk for serious side effects.

      • Mark your calendar with your appointments to see your provider and get any blood tests done on time. This makes sure your health is properly monitored while you receive Tralement (trace elements) through your IV nutrition.

        faqs

        Frequently asked questions about Tralement (trace elements)

        Why are trace elements important?
        Tralement contains four trace elements (zinc, copper, manganese, and selenium). These trace elements play many important roles to keep your body functioning properly. For example, they're important for maintaining your immune system health, making proteins and genetic material in your cells, and supporting the growth and development of your body's organs. Your provider will order Tralement (trace elements) if you're receiving parenteral nutrition (nutrition given through the veins) and can't get these essential minerals from food or drink. Your provider will measure the levels of the trace elements in your blood and will decide if supplementation with Tralement is right for you.
        Does Tralement (trace elements) contain essential elements?
        The four trace elements in Tralement (zinc, copper, manganese, and selenium) are examples of essential elements. Your body needs a small but specific amount of these essential elements to work properly and stay healthy.
        How is Tralement (trace elements) administered?
        Special pharmacies that make parenteral nutrition bags add Tralement (trace elements) to the nutrition mixture. Once the nutrition bag is prepared, the nutrition mixture is infused through your vein (IV). Tralement (trace elements) is never given alone as an injection directly into your veins.
        What's the difference between the trace elements brands Tralement and Multrys?
        Tralement and Multrys both contain the trace elements zinc, copper, manganese, and selenium. Tralement is used for adults and children weighing at least 22 pounds. Multrys is used for infants weighing less than 22 pounds and contains a lower amount of trace elements than Tralement. The amount of trace elements needed in IV nutrition differs with age. Additionally, children typically require very careful dosing to lower the risk of toxicity since their kidney and liver functions are slightly different than adults. Kidney and liver function change with age, and the risk for toxicity depends on how well these organs work. Your care team will use the appropriate trace elements brand and dose based on your weight.
        Can I use Tralement (trace elements) if I have kidney or liver problems?
        Yes, you can still use Tralement (trace elements), but you might need to have your dose adjusted or your blood levels checked more often. This is because having kidney or liver problems can raise your risk for toxicity from certain trace elements. People with kidney problems are at risk of having high aluminum levels, and people with liver problems are at risk for having high copper and manganese levels. The risk might be even higher if you're using Tralement (trace elements) for a long time. Make sure to let your provider know if you have kidney or liver problems.
        Can I use Tralement (trace elements) if I'm pregnant or breastfeeding?
        Tralement (trace elements) use hasn't been studied in people during pregnancy or while breastfeeding. But the recommended dose of Tralement (trace elements) isn't expected to cause serious birth defects, pregnancy loss (miscarriage), or other harm or complications for the mother and baby. In fact, having low blood levels of trace elements while you're expecting can lead to pregnancy complications or be harmful to your baby. Talk with your provider about the risks and benefits of having Tralement (trace elements) in your nutrition mixture if you're breastfeeding, pregnant, or thinking of becoming pregnant.
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        What are the risks and warnings for Tralement (trace elements)?

        Tralement (trace elements) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

        risk-warning

        Toxicity from too much Tralement (trace elements) in the body

        • Risk factors: History of kidney or liver problems | Receiving parenteral nutrition for a long time | Receiving too high of a dose of Tralement (trace elements) | Babies who were born early (premature)

          Supplementation with trace elements can cause you to have levels of zinc, copper, manganese, or selenium in your body that are too high. Products like Tralement (trace elements) also contain some aluminum, so there's a risk of aluminum toxicity as well.

          The risk for toxicity is higher in people taking Tralement (trace elements) long term or in people who have liver or kidney problems. Babies who were born early are also at higher risk since their kidneys aren't fully developed yet. Your care team will check for symptoms and monitor your blood levels of the trace elements before you start IV nutrition. Your providers will continue to check throughout treatment.

          Tell your providers if you have any of the following symptoms. You might need to have your levels urgently checked or your dose adjusted.

          General symptoms: nausea, vomiting, diarrhea, upset stomach, stomach pain, headache, weakness, confusion, or mood changes.
          Too much manganese: tremors (shaking), muscle spasms, movement problems, changes in memory, or seizures.
          Too much selenium: garlic breath odor.
          Too much aluminum: speech problems, bone pain, or seizures.
          Too much copper: metallic taste in mouth.

          risk-warning

          Allergic reactions

          • Risk factors: History of allergies to zinc-containing insulins | History of allergies to copper-containing intrauterine device (IUD)

            Allergic reactions to Tralement (trace elements) are possible. Get medical attention right away if you notice dizziness, hives, a choking sensation, trouble breathing, swelling around your eyes, or swelling of the lips or tongue after using Tralement (trace elements).

            Be sure your care team is aware of all your allergies. Since Tralement (trace elements) contains zinc, your risk might be higher if you've had allergic reactions to zinc-containing insulins like insulin regular (Humulin R or Novolin R). Tralement (trace elements) also contains copper, so you might be at risk of an allergic reaction if you've had a reaction to Paragard (copper IUD).

            dosage

            Tralement (trace elements) dosage forms

            The average cost for 1 vial of 1ml of 3mg/0.3mg/55mcg/60mcg of Tralement (trace elements) is $688.71 with a free GoodRx coupon. This is 91.3% off the average retail price of $7915.90.
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            Vial
            DosageQuantityPrice as low asPrice per unit
            1ml of 3mg/0.3mg/55mcg/60mcg1 vial$688.71$688.71

            Typical dosing for Tralement (trace elements)

            Tralement (trace elements) is added into nutrition bags. Once prepared, the nutrition mixture is given as an infusion through the veins (IV). Your provider will determine the right dose for you based on your body weight.

            Tralement: Each 1 mL contains 3 mg of zinc, 0.3 mg of copper, 55 mcg of manganese, and 60 mcg of selenium.

            • People weighing 22 lbs to 44 lbs: The typical dose is 0.2 mL per day.

            • People weighing 44 lbs to 66 lbs: The typical dose is 0.4 mL per day.

            • People weighing 66 lbs to 88 lbs: The typical dose is 0.6 mL per day.

            • People weighing 88 lbs to 110 lbs: The typical dose is 0.8 mL per day.

            • People weighing 110 lbs or more: The typical dose is 1 mL per day.

            Multrys: Each 1 mL contains 1 mg of zinc, 60 mcg of copper, 3 mcg of manganese, and 6 mcg of selenium.

            • Children weighing less than 22 lbs: The typical dose is 0.2 mL to 1 mL every day or every other day. The specific dose will be based on your child's body weight.

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            contraindications-icon

            Tralement (trace elements) contraindications

            Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Tralement (trace elements) will not be safe for you to take.

            • Allergy to zinc or copper

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            References

            Best studies we found

            American Regent, Inc. (2020). Tralement- trace elements injection 4 injection, solution [package insert]. DailyMed.

            American Regent, Inc. (2021). Multrys- trace elements injection 4 injection, solution [package insert]. DailyMed.

            Batchelor, H. K., et al. (2015). Paediatric pharmacokinetics: Key considerations. British Journal of Clinical Pharmacology.

            View All References (12)

            Berlana, D. (2022). Parenteral nutrition overview. Nutrients.

            Bhattacharya, P. T., et al. (2016). Nutritional aspects of essential trace elements in oral health and disease: An extensive review. Scientifica.

            Dastych, M., et al. (2021). Manganese and copper levels in patients with primary biliary cirrhosis and primary sclerosing cholangitis. Scandinavian Journal of Clinical and Laboratory Investigation.

            Igbokwe, I. O., et al. (2019). Aluminium toxicosis: A review of toxic actions and effects. Interdisciplinary Toxicology.

            Jin, J., et al. (2017). Trace elements in parenteral nutrition: Considerations for the prescribing clinician. Nutrients.

            National Institutes of Health, Office of Dietary Supplements. (2021). Manganese: Fact sheet for consumers.

            National Institutes of Health, Office of Dietary Supplements. (2021). Selenium: Fact sheet for consumers.

            National Institutes of Health, Office of Dietary Supplements. (2022). Copper: Fact sheet for consumers.

            National Institutes of Health, Office of Dietary Supplements. (2022). Zinc: Fact sheet for consumers.

            Rahimzadeh, M. R., et al. (2022). Aluminum poisoning with emphasis on its mechanism and treatment of intoxication. Emergency Medicine International.

            You and Your Hormones. (2020). Thyroid gland.

            Zemrani, B., et al. (2018). Trace element provision in parenteral nutrition in children: one size does not fit all. Nutrients.

            GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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