auranofin [gold] (Ridaura)

Introduction

Tradename: Ridaura. [gold].

Indications

• rheumatoid arthritis, active state,
  • not responding to other agents
• Felty's syndrome
• Still's disease
• psoriatic arthritis

Dosage

Rheumatoid arthritis:

• starting dose: 3 mg PO QD.
• 3 mg PO BID or 6 mg QD, max 9 mg QD divided TID
• discontinue if no response after 3 months on maximum dose

Tabs: 3 mg (29% gold).

Pharmacokinetics

• therapeutic effects may not be apparent for 3-4 months

elimination via kidney

elimination via feces

1/2life = 26 days

protein binding = 60 %

Monitor

• complete blood count (CBC)
• urine for proteinuria & hematuria

Adverse effects

• common (> 10%)
  • dermatitis/skin allergy
  • stomatitis
  • proteinuria (nephrotic syndrome)
• less common (1-10%)
  • hives, alopecia, eosinophilia, leukopenia, thrombocytopenia, glossitis, hematuria
• uncommon (< 1%)
  • angioedema, peripheral neuropathy, dysphagia, ulcerative colitis, GI hemorrhage, agranulocytosis, aplastic anemia, hepatotoxicity, gingivitis, metallic taste, interstitial pneumonitis
• other
  • diarrhea
  • abdominal pain
  • gray-blue pigmentation

Use with caution in patients with:

• hepatic or renal disease
• diabetes
• congestive heart failure
• blood dyscrasias
• hypertension
• compromised cerebral or cardiovascular function

Drug interactions

• may increase phenytoin levels

Mechanism of action

• supresses of prevents arthritis & synovitis
• taken up by macrophages resulting in inhibition of phagocytosis & perhaps lysosomal activity
• decreases serum levels of rheumatoid factor & immunoglobulins
• may decrease synovial inflammation & retard cartilage & bone destruction

More general terms

• disease-modifying antirheumatic agent (DMARD)

Additional terms

• gold [Au]

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=433055