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|Gold Compounds

GOLD COMPOUNDS (Systemic)

Some commonly used brand names are:

In the U.S.—

• Myochrysine ³
• Ridaura ¹
• Solganal ²

In Canada—

• Myochrysine ³
• Ridaura ¹

Category

• Antirheumatic, disease-modifying—Auranofin; Aurothioglucose; Gold Sodium Thiomalate

Description

The gold compounds are used in the treatment of rheumatoid arthritis. They may also be used for other conditions as determined by your doctor.

In addition to the helpful effects of this medicine in treating your medical problem, it has side effects that can be very serious. Before you take this medicine, you should discuss with your doctor the good that this medicine will do as well as the risks of using it.

Auranofin is available only with your doctor"s prescription. The other gold compounds are given by your health care professional.

These medicines are available in the following dosage forms:

• Oral
• Auranofin
  • Capsules (U.S. and Canada)

• Parenteral
• Aurothioglucose
  • Injection (U.S.)
• Gold sodium thiomalate
  • Injection (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For gold compounds, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to gold or other metals, if you have received a gold compound before and developed serious side effects from it, or if any medicine you have taken has caused an allergy or a reaction that affected your blood. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Studies on birth defects with gold compounds have not been done in humans. However, studies in animals have shown that gold compounds may cause birth defects.

Breast-feeding—Aurothioglucose and gold sodium thiomalate pass into the breast milk and may cause unwanted effects in nursing babies. It is not known whether auranofin passes into the breast milk.

Children—Auranofin has been tested only in adult patients and there is no specific information about its use in children. However, aurothioglucose and gold sodium thiomalate have been tested in children and have not been shown to cause different side effects or problems than they do in adults.

Older adults—These medicines have been tested and have not been shown to cause different side effects or problems in older people than they do in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a gold compound, it is important that your health care professional know if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine, especially:

• Penicillamine (e.g., Cuprimine)—The chance of side effects may be increased.

Other medical problems—The presence of other medical problems may affect the use of gold compounds. Make sure you tell your doctor if you have any other medical problems, especially:

• Blood or blood vessel disease or
• Colitis or
• Kidney disease (or history of) or
• Lupus erythematosus or
• Sjögren"s syndrome or
• Skin disease—The chance of unwanted effects may be increased

Proper Use of This Medicine

In order for this medicine to work, it must be taken regularly as ordered by your doctor. Continue receiving the injections or taking auranofin even if you think the medicine is not working. You may not notice the effects of this medicine until after three to six months of regular use.

For patients taking auranofin :

• Do not take more of this medicine than ordered by your doctor . Taking too much auranofin may increase the chance of serious unwanted effects.

If you have any questions about this, check with your doctor.

Dosing—The dose of these medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

• For auranofin
• For oral dosage form (capsules):
  • For arthritis:
    • Adults—6 milligrams (mg) once a day or 3 mg twice a day. After six months, your doctor may increase the dose to 3 mg three times a day.
    • Children—Dose must be determined by your doctor.

• For aurothioglucose
• For injection dosage form:
  • For arthritis:
    • Adults and teenagers—10 milligrams (mg) for the first dose, then 25 mg once a week for the next two weeks, then 25 or 50 mg once a week. The medicine is injected into a muscle. After several months, the injections may be given less often (25 or 50 mg every two weeks for a while, then every three or four weeks).
    • Children 6 to 12 years of age—2.5 mg for the first dose, then 6.25 mg once a week for the next two weeks, then 12.5 mg once a week. The medicine is injected into a muscle. After several months, the injections may be given less often (6.25 or 12.5 mg every three or four weeks).
    • Children younger than 6 years of age—Dose must be determined by your doctor.

• For gold sodium thiomalate
• For injection dosage form:
  • For arthritis:
    • Adults and teenagers—10 milligrams (mg) for the first dose, then 25 mg a week later, then 25 or 50 mg once a week. The medicine is injected into a muscle. After several months, the injections may be given less often (25 or 50 mg every two weeks for a while, then every three or four weeks).
    • Children—10 mg for the first dose, then 1 mg per kilogram (about 0.45 mg per pound) of body weight, but not more than a total of 50 mg, once a week. The medicine is injected into a muscle. After several months, the same dose may be given less often (every two weeks for a while, then every three or four weeks).

Missed dose—For patients taking auranofin: If you miss a dose of this medicine, and your dosing schedule is—

• One dose a day—Take the missed dose as soon as possible. However, if you do not remember until the next day, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
• More than one dose a day—Take the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Gold compounds may cause some people to become more sensitive to sunlight than they are normally. These people may break out in a rash after being in the sun, or a skin rash that is already present may become worse. To protect yourself, it is best to:

• Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
• Wear protective clothing.
• Ask your doctor if you may apply a sun block product. Products that have a skin protection factor (SPF) of at least 15 work best, but some patients may require a product with a higher SPF number, especially if they have a fair complexion.
• Do not use a sunlamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

For patients taking auranofin :

• Your doctor should check your progress at regular visits. Blood and urine tests may be needed to make certain that this medicine is not causing unwanted effects.

For patients receiving gold injections :

• Immediately following an injection of this medicine, side effects such as dizziness, feeling faint, flushing or redness of the face, nausea or vomiting, increased sweating, or unusual weakness may occur. These will usually go away after you lie down for a few minutes. If any of these effects continue or become worse, or if you notice any other effects within 10 minutes or so after receiving an injection, tell your health care professional right away.
• Joint pain may occur for 1 or 2 days after you receive an injection of this medicine. This effect usually disappears after the first few injections. However, if this continues or is bothersome, check with your doctor.

Side Effects of This Medicine

Gold compounds have been shown to cause tumors and cancer of the kidney when given to animals in large amounts for a long time. However, these effects have not been reported in humans receiving gold compounds for arthritis. If you have any questions about this, check with your doctor.

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if the following side effects continue or are bothersome:

Some patients receiving auranofin have noticed changes in the taste of certain foods. If you notice a metallic taste while receiving any gold compound, check with your doctor as soon as possible. If you notice any other taste changes while you are taking auranofin, it is not necessary to check with your doctor unless you find this effect especially bothersome.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 12/21/1999

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