| Auranofin
Auranofin (Ridaura)
Auranofin
(or-AN-oh-fin)
Pregnancy Category: C Ridaura
(Rx)
Classification: Antiarthritic,
oral gold compound
Action/Kinetics: Auranofin is a
gold-containing (29%) compound for PO administration. It has fewer side effects than
injectable gold products. Although the mechanism is not known, auranofin will improve
symptoms of rheumatoid arthritis; it is most effective in the early stages of active
synovitis and may act by inhibiting sulfhydryl systems. Other possible mechanisms include
inhibition of phagocytic activity of macrophages and polymorphonuclear leukocytes,
alteration of biosynthesis of collagen, and alteration of the immune response. Gold will
not reverse damage to joints caused by disease. Approximately 25% of an oral dose is
absorbed. Plasma t1/2 of auranofin gold: 26 days. Onset: 3-4 months
(up to 6 months in certain clients). Approximately 3 months are required for steady-state
blood levels to be achieved. The drug is metabolized and excreted in both the urine and
feces.
Uses: Adults and children with
rheumatoid arthritis that have not responded to other drugs. Up to 6 months may be
required for beneficial effects to occur. Auranofin should be part of a total treatment
regimen for rheumatoid arthritis, including nondrug treatments.
Contraindications: History of
gold-induced disorders including necrotizing enterocolitis, pulmonary fibrosis,
exfoliative dermatitis, bone marrow aplasia, or other hematologic severe disorders. Use
during lactation.
Special Concerns: Use with
extreme caution in renal or hepatic disease, skin rashes, marked hypertension, compromised
cerebral or CV circulation, or history of bone marrow depression (e.g., agranulocytopenia,
anemia). Gold dermatitis may be aggravated by exposure to sunlight. Although used in
children, a recommended dosage has not been established. Tolerance to gold is often
decreased in geriatric clients.
Side Effects: GI:
N&V, diarrhea (common), abdominal pain, metallic taste, stomatitis, glossitis,
gingivitis, anorexia, constipation, flatulence, dyspepsia, dysgeusia, melena. Rarely,
dysphagia, GI bleeding, ulcerative enterocolitis. Dermatologic:
Skin rashes, pruritus, alopecia, urticaria, angioedema, actinic rash. Hematologic:
Leukopenia, anemia, thrombocytopenia (with or without purpura), neutropenia,
agranulocytosis, eosinophilia, pancytopenia, hypoplastic anemia, aplastic
anemia pure red cell aplasia. Renal: Proteinuria, hematuria. Hepatic:
Jaundice (with or without cholestasis, hepatitis with jaundice, toxic
hepatitis intrahepatic cholestasis. Other: Conjunctivitis,
cholestatic jaundice, fever, interstitial pneumonia and fibrosis, peripheral neuropathy.
Laboratory Test Alterations:  Liver enzymes.
Overdose Mangement: Symptoms:
Rapid appearance of hematuria, proteinuria, thrombocytopenia, granulocytopenia. Also,
N&V, diarrhea, fever, urticaria, papulovesicular lesions, urticaria, exfoliative
dermatitis, pruritus. Treatment: Discontinue promptly and give dimercaprol.
Supportive therapy should be provided for renal and hematologic symptoms. Treat moderately
severe skin and mucous membrane symptoms with topical corticosteroids, oral
antihistamines, and anesthetic lotions. Treat severe stomatitis or dermatitis with
prednisone, 10-40 mg daily. Treat serious renal, hematologic, pulmonary, and enterocolitic
complications with prednisone, 40-100 mg daily in divided doses. The duration of treatment
varies, depending on the severity of symptoms and the response to steroids. In acute
overdosage, induce emesis or perform gastric lavage immediately.
How Supplied: Capsule: 3
mg
Dosage
•Capsules Rheumatoid arthritis.
Adults, initial: Either 6 mg/day or 3 mg b.i.d. If response is unsatisfactory after
6 months, increase to 3 mg t.i.d. If response is still inadequate after 3 additional
months, discontinue the drug. Dosages greater than 9 mg/day are not recommended.
Children, initial: 0.1 mg/kg/day; maintenance: 0.15 mg/kg/day, not to exceed
0.2 mg/kg/day.
Transfer from injectable gold.
Discontinue injectable gold and begin auranofin at a dose of 6 mg/day. |
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