Auranofin
Pronouncation: (or-RAIN-oh-fin)Class: Gold compound
Trade Names:
Ridaura
- Capsules 3 mg
Pharmacology
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Feedback for Auranofin
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Gold compounds relieve symptoms of arthritis but do not cure this disease; decrease rheumatoid factor concentrations and immunoglobulins.
Pharmacokinetics
Absorption
Because of rapid metabolism, intact auranofin has never been detected in the blood. Approximately 25% of the gold in auranofin is absorbed. Steady-state gold concentrations of approximately 0.68 mcg/mL are achieved in approximately 3 mo.
Distribution
Approximately 40% of auranofin gold is associated with red cells, and 60% is associated with serum proteins.
Metabolism
Rapidly metabolized.
Elimination
Mean terminal plasma t ½ of auranofin gold at steady-state is 26 days. Approximately 60% of absorbed gold of single auranofin dose is excreted in urine; remainder is excreted in the feces.
Indications and Usage
Relief of symptoms of active adult rheumatoid arthritis poorly controlled with other therapies.
Unlabeled Uses
Treatment of pemphigus and psoriatic arthritis.
Contraindications
Standard considerations.
Dosage and Administration
AdultsPO 6 mg/day or 3 mg twice daily. If no response by 6 mo, dose may be increased to 3ߙmg 3 times daily. Parenteral route may be used when control cannot be achieved by oral form.
ChildrenAuranofin is not recommended for children; safety and efficacy have not been established. If prescribed, however, the following doses have been recommended. 0.1ߙmg/kg/day (initial dose); 0.15 mg/kg/day (maintenance dose); 0.2 mg/kg/day (max dose).
Storage/Stability
Protect product from light and moisture.
Drug Interactions
None well documented.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Reactions can occur months after therapy is discontinued.
CNS
Confusion; hallucinations; seizures.
Dermatologic
Dermatitis; pruritus; grey-blue pigmentation on sun-exposed skin; exfoliative dermatitis; angioedema.
EENT
Mucositis that may be preceded by metallic taste; conjunctivitis; corneal gold deposition; metallic taste; inflammation of the upper respiratory tract; pharyngitis.
GI
Diarrhea; abdominal pain; anorexia; dyspepsia; flatulence; GI bleeding; enterocolitis; gastritis; colitis; tracheitis.
Genitourinary
Nephrotic syndrome and glomerulitis with proteinuria and hematuria.
Hematologic
Anemia; thrombocytopenia; leukopenia; aplastic anemia.
Hepatic
Elevated liver enzymes; jaundice; hepatitis.
Respiratory
Interstitial pneumonitis; pulmonary fibrosis.
Miscellaneous
Vaginitis; glossitis.
Precautions
MonitorLab valuesReview laboratory values for indications of gold toxicity such as decreased hemoglobin, less than 4,000ߙWBC/mm 3 , platelets less than 100,000 to 150,000/cu mm, proteinuria, and elevated liver enzymes. ToxicityObserve patient for early symptoms of toxicity such as a metallic taste in the mouth, pruritus or rash. |
Pregnancy
Category C .
Lactation
Excreted in breast milk.
Children
Safety and efficacy not established.
Elderly
Tolerance decreases with age.
Special Risk Patients
Use with caution in patients with diabetes mellitus, CHF, history of blood dyscrasias, allergy or hypersensitivity to other gold products, skin rash, previous kidney or liver disease, marked hypertension, compromised circulation or inflammatory bowel disease.
Overdosage
Symptoms
Renal damage (eg, hematuria, proteinuria), hematologic reactions (eg, thrombocytopenia), nausea, vomiting, diarrhea, fever, skin disorders.
Patient Information
- Instruct patient to immediately report any adverse effects of therapy including dermatitis and pruritus, weakness, fatigue, hematuria, sore mouth, indigestion, diarrhea, metallic taste in mouth, or unusual bruising.
- Caution patient to minimize exposure to the sun and other sources of ultraviolet light. Explain the need to wear sunscreen and protective clothing outdoors.
- Advise patient to keep appointments with health care providers for continued assessment and monitoring of renal, hepatic and hematologic functions.
- Review oral hygiene, including use of soft toothbrush, daily flossing and avoidance of strong, commercial mouthwashes. If mild stomatitis develops, an isotonic NaCl and sodium bicarbonate solution can be used.
- Alert women to the potential risks of using gold therapy during pregnancy.
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More Auranofin resources:
Auranofin - Includes detailed dosage instructions.
Rheumatoid Arthritis, Psoriatic Arthritis, Pemphigus, Felty's Syndrome
