Classifications: gold compound; antiinflammatory; antirheumatic; Therapeutic: antiinflammatory; antirheumatic
Pregnancy Category: C
3 mg capsules
Strongly lipophilic and almost neutral in solution, properties that may facilitate transport of agent across cell membranes.
Action appears to be immunomodulatory: serum immunoglobulin concentrations and rheumatoid factor titers are decreased; and
antiinflammatory: gold is taken up by macrophages with resulting inhibition of phagocytosis and lysosomal enzyme release.
Auranofin is immunomodulatory and antiinflammatory.
Management of active stage of classic or definite rheumatoid arthritis in adults who do not respond to or tolerate other
antiarthritis agents (e.g., NSAIDs, other gold compounds).
Juvenile rheumatoid arthritis, active SLE, psoriatic arthritis.
History of gold-induced necrotizing enterocolitis, renal disease, exfoliative dermatitis or bone marrow aplasia; patient
who has recently received radiation therapy, history of severe toxicity from previous exposure to gold or other heavy metals;
uncontrolled CHF; marked hypertension; SLE; pregnancy (category C), lactation.
Inflammatory bowel disease, rash, liver disease, renal disease; history of bone marrow depression; older adults; diabetes
Route & Dosage
Adult: PO 6 mg/d in 12 divided doses, may increase to 69 mg/d in 3 divided doses after 6 mo (max: 9 mg/d)
Child: PO Initially 0.1 mg/kg/d, may increase to 0.15 mg/kg/d in 12 divided doses (max: 0.2 mg/kg/d)
- Give capsule with food or fluid of patient's choice.
- Store at 15°30° C (59°86° F); protect from light and moisture.
- Note: Expiration date is 4 y after date of manufacture.
Adverse Effects (≥1%) GI: Diarrhea, abdominal cramping
and pain; nausea,
vomiting, anorexia, dysphagia; stomatitis,
glossitis, metallic taste; flatulence, constipation
, GI bleeding, melena. Hematologic: Thrombocytopenia, leukopenia,
eosinophilia, agranulocytosis, aplastic anemia. Urogenital:
Proteinuria, hematuria, renal failure. Skin: Rash, pruritus,
Diagnostic Test Interference
Auranofin may enhance response to a tuberculin skin test.
20% from small intestine. Peak:
2 h. Distribution:
Highest concentrations in kidneys, spleen, lungs, adrenals, and liver; unknown if crosses placenta; small amounts distributed
into breast milk. Elimination:
60% of absorbed gold eliminated in urine, remainder in feces. Half-Life:
Assessment & Drug Effects
- Monitor for therapeutic effectiveness which develops slowly and is not usually apparent for 34 mo.
- Report any of the following S&S promptly: unexplained bleeding or bruising, metallic taste, sore mouth; pruritus, rash;
diarrhea and melena; yellow skin and sclera; unexplained cough or dyspnea.
- Lab tests: Test for signs of possible impending gold toxicity including decreased Hgb; leukocytes <4000/mm3; granulocytes <1500/mm3; platelets <150,000/mm3; proteinuria <500 mg/d. Also urinary protein and hepatic function.
- Note: Drug-induced thrombocytopenia is usually spontaneously reversible several weeks after drug is withdrawn.
- Continue medical surveillance and supportive therapy after drug is discontinued because adverse effects (such as difficulty
in breathing, diarrhea and abdominal pain, fatigue, weakness, unexplained bleeding and bruising, metallic taste) may persist
for many months.
Patient & Family Education
- Report adverse effects of therapy, especially abdominal cramping and pain; discontinuance of therapy may be necessary.
- Report metallic taste and pruritus with or without rash. These are among earliest symptoms of impending gold toxicity.
- Do not change dosage (dose or dose interval) by omission, increase, or decrease without first consulting physician.
- Use antidiarrheal OTC drug and high-fiber diet for drug-induced diarrhea.
- Avoid exposure to sunlight (especially between 10 a.m. and 4 p.m.) or to artificial ultraviolet light to prevent photosensitivity
- Rinse mouth with water frequently for symptomatic treatment of mild stomatitis. Avoid commercial mouth rinses; clean teeth
with soft tooth brush and gentle brushing to avoid gingival trauma. Floss at least once daily.