gold sodium thiomalate (Rx)

Brand and Other Names:aurothiomalate, sodium, Myochrysine, more...sodium aurothiomalate
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 25mg/mL
  • 50mg/mL
more...

Rheumatoid Arthritis

Indicated for rheumatoid arthritis in patients who have failed adequate trials of NSAIDs

10 mg IM the 1st wk, 25 mg IM the 2nd wk, then 25-50 mg IM qWk x 20 wk or until toxicity occurs

Taper to 50 mg IM q2-4wk

CrCl <50 mL/min, not recommended

Dosage Forms & Strengths

injectable solution

  • 25mg/mL
  • 50mg/mL
more...

Juvenile Idiopathic Arthritis (Off-label)

10 mg IM the 1st wk, then 1 mg/kg IM qWk; not to exceed 50 mg/dose 

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Interactions

Interaction Checker

and gold sodium thiomalate

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Pruritis & rash (30%)

            Stomatitis (20%)

            Proteinuria (10-15%)

            1-10%

            Leukopenia

            Thrombocytopenia

            Frequency Not Defined

            Agranulocytosis

            Aplastic anemia

            Exfoliative dermatitis

            Enterocolitis

            Liver failure

            Anaphylactoid rxn

            Nephropathy

            Corneal gold deposits (rare)

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            Warnings

            Black Box Warnings

            Prescribing physicians should understand severe and fatal toxicities of chrysotherapy

            Thorough patient discussion explaining adverse reactions is essential; encourage patients to report any adverse reactions

            Monitor for signs of gold toxicity (ie, decreased hemoglobin, leukopenia <4,000/mm³, granulocytes <1,500/mm³, platelets <150,000/mm³, proteinuria, hematuria, pruritus, rash, stomatitis, persistent diarrhea) and establish baseline measurements before prescribing

            Should be reserved for use in certain patients with active rheumatoid arthritis

            Contraindications

            Hypersensitivity to gold

            History of previous gold-induced disorders (anaphylaxis, necrotizing enterocolitis, pulmonary fibrosis, dermatitis, bone marrow suppression, or other hematologic disorder)

            Cautions

            Not to be used as sole agent in treatment of RA

            No evidence gold compounds induce remission of RA

            Gold toxicity:

            • Hemoglobin (decr)
            • Leukopenia (WBC <4000/cu.mm) [4 x10^9/L]
            • Granulocytes (<1500/cu.mm) [1.5 x10^9/L]
            • Platelets (<150 x 10^3/cu.mm) [150 x10^9/L]
            • Proteinuria, hematuria, pruritus, rash, stomatitis, chronic diarrhea

            Discontinue if evidence of anaphylaxis

            If nitritoid reaction (flushing, tachycardia, faintness) within minutes of injection, resume treatment only with caution in patients with compromised CV status

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: enters breast milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Unknown

            Gold compound, has anti-inflammatory, antiarthritic and immunomodulating effects; suppresses synovitis in active rheumatoid disease

            Pharmacokinetics

            Onset of effect: 2-6 months

            Protein bound: High

            Half-life: 6-25 days

            Excretion: 60-90% urine; 10-40% feces

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.