How to Help Your Patients Find Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate in Stock: A Provider's Guide

Your Patients Need Trace Elements — Here's How to Help Them Get Them

For providers managing patients on parenteral nutrition, few things are more frustrating than knowing your patient needs Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate and not being able to find it. As Tralement and Multrys continue to face intermittent supply constraints in 2026, clinicians play a critical role in helping patients navigate the shortage.

This guide provides five actionable steps your team can take, along with information on current availability, alternatives, and workflow tips to manage shortage-related disruptions.

Current Availability: What to Expect in 2026

Tralement (for patients ≥10 kg) and Multrys (for patients <10 kg) remain in production by American Regent, but supply does not consistently meet demand. Key points:

• Wholesalers may impose allocation limits — restricting how many vials a pharmacy can order per period
• Home infusion pharmacies report intermittent stockouts lasting days to weeks
• Individual trace element products (zinc sulfate, cupric chloride, selenious acid, manganese sulfate) are more widely available and sourced from multiple manufacturers
• 503B outsourcing pharmacies continue to offer compounded trace element solutions

Why Patients Can't Find It

Patients on home parenteral nutrition face unique challenges in securing this medication:

• They can't just go to any pharmacy. Trace element injections are specialty products that require sterile compounding into PN bags — retail pharmacies don't carry them.
• They depend on a single home infusion provider. Most patients work with one home infusion pharmacy. If that pharmacy can't source the product, the patient is stuck.
• They may not know alternatives exist. Many patients are unaware that individual trace elements or 503B compounded solutions are viable substitutes.
• Insurance complexities. Switching to alternative products may require new orders, updated authorizations, or different billing codes — all of which take time.

What Providers Can Do: 5 Actionable Steps

Step 1: Use Medfinder for Providers to Locate Stock

Medfinder for Providers is a free tool designed to help clinicians find hard-to-source medications. Search for Tralement or trace elements injection to see which suppliers currently have stock. This can replace time-consuming calls to multiple distributors.

Step 2: Proactively Communicate With Home Infusion Pharmacies

Don't wait for the patient to report a problem. Establish regular communication with your patients' home infusion pharmacies about trace element supply status. Ask them to notify your office immediately if allocation limits are imposed or if they anticipate a stockout.

Consider designating a nutrition support coordinator or nurse to serve as the liaison between your clinic, the patient, and the home infusion pharmacy.

Step 3: Have a Standing Backup Order for Individual Trace Elements

Prepare a template backup order that can be quickly activated if the combination product becomes unavailable. This order should include:

• Zinc Sulfate Injection — dosed to provide the equivalent zinc content
• Cupric Chloride Injection — dosed for equivalent copper
• Selenious Acid Injection — dosed for equivalent selenium
• Manganese Sulfate or Manganese Chloride Injection — dosed for equivalent manganese (with attention to not exceeding 1 mcg/kg/day)

Having this order template ready means you can switch to individual products within hours instead of days.

Step 4: Identify 503B Compounding Pharmacy Partners

Build a relationship with one or more 503B outsourcing pharmacies that offer compounded trace element solutions. These pharmacies can prepare multi-trace element combinations when commercially manufactured products are unavailable. Key considerations:

• Verify the pharmacy is registered with the FDA and compliant with cGMP standards
• Confirm they can supply the specific trace element concentrations your patients need
• Understand their lead times and minimum order quantities

Step 5: Increase Monitoring During Shortage Periods

When patients are receiving inconsistent trace element supplementation — whether due to supply gaps or switches between products — increase your monitoring frequency:

• Serum zinc levels every 2–4 weeks (vs. quarterly in stable patients)
• Serum copper and ceruloplasmin
• Serum selenium or glutathione peroxidase activity
• Whole blood manganese (especially in patients with liver disease)
• Clinical assessment for deficiency signs: dermatitis, alopecia, anemia, muscle weakness, or immune dysfunction

Alternatives at a Glance

When Tralement or Multrys is unavailable, the main alternatives include:

• Individual trace element injections: Available from multiple manufacturers; requires separate sourcing and compounding
• 503B compounded solutions: Custom-prepared multi-trace element combinations from outsourcing pharmacies
• Adjusted PN formulations: Temporary omission of specific trace elements (with increased monitoring) as a last resort

For a detailed discussion of alternatives, refer patients to our guide on alternatives to Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate.

Workflow Tips for Managing Shortage Disruptions

• Build trace element supply status into your PN renewal workflow. Every time you renew a PN order, confirm trace element availability with the pharmacy.
• Document shortage-related substitutions. Note in the medical record when individual trace elements are substituted for the combination product, including specific dosing calculations.
• Educate your patients. Provide patients with information about the shortage so they understand why their PN may temporarily change. Share our patient-facing guides on the 2026 shortage update and how to find the medication in stock.
• Advocate for supply chain diversification. Support professional society efforts (ASPEN, Oley Foundation) to encourage additional manufacturers to enter the market.

Final Thoughts

The trace elements shortage requires providers to be proactive rather than reactive. By using tools like Medfinder for Providers, maintaining backup orders, partnering with 503B pharmacies, and increasing monitoring during supply gaps, you can help ensure your patients continue to receive the essential minerals they need. Trace element deficiencies are preventable — but only if we act before they develop.