gold sodium thiomalate; aurothiomalate (Myochrysine, Chrysothios)
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Introduction
Tradename: Myochrysine.
Indications
- progressive rheumatoid arthritis
- psoriatic arthritis[2]
Dosage
- adults
- 10 mg IM 1st week (test dose)
- 25-50 mg/week IM until cumulative dose of 1000 mg
- 25-50 mg IM every 2-3 weeks for 2-20 weeks
- thereafter 25-50 mg IM every 3-4 weeks
- Veterans administration uses doses at least as large as 75 mg weekly
- children
Injection (50% gold): 25 mg/mL (1 mL); 50 mg/mL (1 mL, 10 mL)
Pharmacokinetics
- administration for 2-4 months generally required before clinical improvement is noted
elimination via kidney
elimination via feces
1/2life = 3-27 days
protein binding = 99 %
Monitor
- CBC no more than 4 days prior to injection; gold should not be administered if platelet count is < 140,000/uL, WBC < 4000/uL, hemoglobin < 8 g/dL
- urinalysis no more than 4 days prior to injection; gold should not be administered if > trace protein
- basic chemistry panel & liver panel every 8-12 weeks
- do not inject if symptoms of adverse effects[2]
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- angioedema, peripheral neuropathy, difficulty swallowing, ulcerative enterocolitis, GI hemorrhage, agranulocytosis, anemia, aplastic anemia, hepatotoxicity, metallic taste, interstitial pneumonitis, gray to blue pigmentation