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All about: Auranofin

Big Image Pronouncation: (or-RAIN-oh-fin)
Class: Gold compound

Trade Names:
Ridaura
- Capsules 3 mg

Mechanism of Action

Pharmacology

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

Adults

PO 6 mg/day or 3 mg twice daily. If no response by 6 mo, dose may be increased to 3 mg 3 times daily. Parenteral route may be used when control cannot be achieved by oral form.

Children

Auranofin is not recommended for children; safety and efficacy have not been established. If prescribed, however, the following doses have been recommended. 0.1 mg/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

Monitor

Lab values

Review laboratory values for indications of gold toxicity such as decreased hemoglobin, less than 4,000 WBC/mm 3 , platelets less than 100,000 to 150,000/cu mm, proteinuria, and elevated liver enzymes.

Toxicity

Observe 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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