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Auranofin (Ridaura)
(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 t 1/2 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

•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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