AURANOFIN
AURANOFIN  (au-rane'eh-fin)  Ridaura Classifications: gold compound; antiinflammatory; antirheumatic; Therapeutic: antiinflammatory; antirheumatic Pregnancy Category: C |
Availability
3 mg capsules
Action
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.
Therapeutic Effect
Auranofin is immunomodulatory and antiinflammatory.
Uses
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).
Unlabeled Uses
Juvenile rheumatoid arthritis, active SLE, psoriatic arthritis.
Contraindications
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.
Cautious Use
Inflammatory bowel disease, rash, liver disease, renal disease; history of bone marrow depression; older adults; diabetes mellitus, CHF.
Route & Dosage
| Rheumatoid Arthritis Adult: PO 6 mg/d in 1–2 divided doses, may increase to 6–9 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 1–2 divided doses (max: 0.2 mg/kg/d) |
Administration
Oral- 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, dermatitis, urticaria.Diagnostic Test Interference
Auranofin may enhance response to a tuberculin skin test.
Pharmacokinetics
Absorption: 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: 11–23 d.Nursing Implications
Assessment & Drug Effects
- Monitor for therapeutic effectiveness which develops slowly and is not usually apparent for 3–4 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 reaction.
- 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.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; Prototype drug