Alternatives to Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate If You Can't Fill Your Prescription

When Your Trace Elements Injection Is Unavailable, Here Are Your Options

If you rely on parenteral nutrition and your pharmacy can't find Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate — sold as Tralement or Multrys — it's natural to feel worried. These trace minerals are essential for your health, and going without them is not a good long-term option.

The good news is that alternatives exist. In this guide, we'll explain what this medication does, how it works, and walk through the realistic alternatives available in 2026.

What Is Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate?

This is a combination injectable product that delivers four trace minerals into the bloodstream:

• Zinc — supports immune function, wound healing, and cell growth
• Copper — essential for iron metabolism, connective tissue formation, and nervous system health
• Manganese — involved in bone development, blood clotting, and carbohydrate metabolism
• Selenium — critical for thyroid function and antioxidant defense

It's used as an additive to parenteral nutrition (TPN) for patients who cannot eat or absorb food through their digestive system. Conditions like short bowel syndrome, severe Crohn's disease, intestinal failure, and certain cancers often require long-term TPN with trace element supplementation.

How Does It Work?

When you can't absorb nutrients through your gut, parenteral nutrition delivers everything you need — calories, protein, fats, vitamins, and minerals — directly into your bloodstream through an IV. Trace elements like zinc, copper, manganese, and selenium serve as cofactors for enzymes throughout your body. Without them, critical processes like immune response, thyroid hormone production, and antioxidant protection begin to break down.

Tralement provides all four minerals in a single, pre-mixed vial that gets added to your daily PN bag. Each 1 mL vial contains zinc 3 mg, copper 0.3 mg, manganese 55 mcg, and selenium 60 mcg — carefully dosed to meet daily requirements for adults and children over 10 kg.

Alternative 1: Individual Trace Element Injections

The most common alternative when the combination product is unavailable is to use separate, individual trace element injections. These include:

• Zinc Sulfate Injection — available as a standalone injectable product
• Cupric Chloride Injection — provides copper
• Selenious Acid Injection — provides selenium
• Manganese Sulfate Injection (or Manganese Chloride) — provides manganese

Your pharmacist would add each of these separately to your parenteral nutrition bag, matching the doses to what you'd normally receive from Tralement. This approach requires more preparation time and more individual product sourcing, but it delivers the same essential minerals.

Key consideration: Individual trace element products may also experience shortages, but they are generally available from more sources than the combination product. Your pharmacist can usually find at least some of these to partially supplement your PN.

Alternative 2: Compounded Trace Element Solutions

Outsourcing pharmacies registered under Section 503B of the Federal Food, Drug, and Cosmetic Act can compound sterile trace element solutions. These compounded products are not FDA-approved in the same way as Tralement, but they are produced under FDA oversight and must meet current good manufacturing practice (cGMP) standards.

503B pharmacies can prepare multi-trace element combinations similar to Tralement, tailored to your specific dosing needs. Your prescriber would need to order from one of these pharmacies directly.

Key consideration: Not all 503B pharmacies carry trace elements. Empower Pharmacy is one example of a 503B compounder that has offered trace element solutions. Ask your care team about options in your area.

Alternative 3: Multrys (for Pediatric Patients)

If you're looking for alternatives for a child weighing less than 10 kg, Multrys is the FDA-approved option. It contains the same four trace elements as Tralement but in lower concentrations appropriate for smaller patients. Multrys provides zinc 1,000 mcg, copper 60 mcg, manganese 3 mcg, and selenium 6 mcg per mL.

Multrys is also manufactured by American Regent, so it may face similar supply constraints. If Multrys is unavailable for your child, individual trace element products with weight-based dosing are the standard backup.

Alternative 4: Adjusted PN Formulations

In some cases, your nutrition support team may temporarily adjust your parenteral nutrition to partially compensate for missing trace elements. For example:

• If selenium is the only element that's unavailable, a short-term PN formulation without selenium may be acceptable with close monitoring of blood levels.
• Your doctor may increase monitoring of serum zinc, copper, selenium, and manganese levels to catch any deficiency early.
• Oral supplements may be considered for patients who have some absorptive capacity, though this is not a reliable substitute for most TPN-dependent patients.

Important: Never adjust your PN formulation on your own. Any changes should be made by your healthcare team.

Final Thoughts

Losing access to Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate is stressful, but there are real alternatives. Individual trace element injections are the most common substitute, and 503B compounding pharmacies offer another path. The most important step is to communicate early and often with your care team when supply gets tight.

Use Medfinder to check current availability and read more in our shortage update for patients and guide to saving money on this medication.