Why Is Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate So Hard to Find? [Explained for 2026]

If You Depend on Trace Elements Injection, You're Not Alone in Struggling to Find It

If you or a loved one relies on parenteral nutrition (also called TPN or IV nutrition), you already know how stressful it can be when a critical component goes missing. Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate — sold under the brand names Tralement and Multrys — is an essential trace element injection that many patients simply cannot go without. Yet in 2026, finding it in stock remains a real challenge for patients, caregivers, and even healthcare providers.

In this article, we'll explain exactly what this medication is, why it keeps running into supply problems, and what steps you can take to secure your supply.

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

This medication is a combination of four essential trace minerals — zinc, copper, manganese, and selenium — delivered directly into the bloodstream through an IV. It is added to parenteral nutrition solutions for patients who cannot eat by mouth or absorb nutrients through their digestive system.

The brand name Tralement is approved for adults and children weighing at least 10 kg (about 22 pounds). A related product, Multrys, is designed for smaller pediatric patients weighing less than 10 kg. Both are manufactured by American Regent, Inc.

These trace minerals are not optional extras — they are essential for immune function, wound healing, thyroid health, bone development, and dozens of enzyme reactions throughout the body. Without them, patients on long-term parenteral nutrition can develop serious deficiency syndromes.

Why Is It So Hard to Find in 2026?

There are several reasons this medication has been persistently difficult to locate:

1. There Is Only One FDA-Approved Manufacturer

American Regent is currently the sole manufacturer of FDA-approved multi-trace element injections in the United States. When a single company is responsible for the entire supply, any disruption — a factory maintenance shutdown, a raw material delay, or a spike in demand — can cause widespread shortages almost overnight.

2. Older Products Were Discontinued

For decades, hospitals and home infusion pharmacies relied on products like Multitrace-4 and Multitrace-5. These were marketed without full FDA approval. After the FDA approved Tralement in July 2020, the older products were phased out. While Tralement is a better, properly approved product, the transition reduced the number of available options and concentrated supply into fewer product lines.

3. Demand Continues to Rise

The number of patients on home parenteral nutrition has grown steadily. Conditions like short bowel syndrome, severe Crohn's disease, and certain cancers can all require long-term IV nutrition. More patients mean more demand for every component of TPN — including trace elements.

4. Complex Manufacturing Process

Sterile injectable products require highly controlled manufacturing environments. The production of multi-trace element injections involves precise formulation of multiple mineral salts in a sterile solution. Any quality issue can halt production and delay shipments for weeks or even months.

What Can You Do If You Can't Find It?

If your pharmacy or home infusion company is having trouble sourcing Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate, here are some practical steps:

Use Medfinder to Check Availability

Tools like Medfinder can help you locate pharmacies and suppliers that currently have trace element products in stock. This can save you hours of phone calls.

Talk to Your Home Infusion Pharmacy

Your home infusion provider often has direct relationships with wholesalers and may be able to source the medication through alternate distribution channels. Ask them to check with their Group Purchasing Organization (GPO).

Ask About Individual Trace Element Injections

If the combination product is unavailable, your doctor and pharmacist may be able to substitute individual trace element injections — separate vials of zinc sulfate, cupric chloride, selenious acid, and manganese sulfate. This approach requires more preparation time but can bridge a gap during shortages.

Check 503B Compounding Pharmacies

Some outsourcing pharmacies (known as 503B pharmacies) can compound trace element solutions. Ask your healthcare team whether a compounded alternative is appropriate for your situation.

Stay in Close Contact With Your Care Team

Your nutrition support team — including your gastroenterologist, dietitian, and pharmacist — should be aware of any supply difficulties. They can adjust your PN formulation, monitor your trace element levels more frequently, and plan ahead if a shortage is expected.

Final Thoughts

The shortage of Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate is frustrating, but it's not something you have to navigate alone. Understanding why the supply is limited is the first step, and taking proactive measures — from using availability tools like Medfinder to exploring alternatives with your care team — can help ensure you don't miss the essential trace minerals your body needs.

For more information, check out our guides on how to find Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate in stock near you and alternatives if you can't fill your prescription.