Test baseline copper, zinc and ceruloplasmin levels. Ceruloplasmin is a carrier protein that transports as much as 90% of serum copper, and is another measure of copper levels in the body.
Goal at 90 days of therapy is ceruloplasmin level 15-20% of baseline level and Zinc:Copper ratio of 3:1.
Start TM (tetrathiomolybdate). Typical starting dose is 40mg 3x/day before meals, and 60mg at bedtime or in middle of night. The daytime doses absorb copper from diet while the overnight dose chelates from system.
Start zinc 30-50mg daily.
Check labs every 4 weeks to start, every 2 weeks as nearing target levels, then weekly until stable at target.
