gold sodium thiomalate (Discontinued)

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

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

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

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    No Interactions Found
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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (5)

              • influenza virus vaccine quadrivalent, adjuvanted

                gold sodium thiomalate decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine trivalent, adjuvanted

                gold sodium thiomalate decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • penicillamine

                gold sodium thiomalate, penicillamine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased potential for serious bone marrow suppression or renal toxicity.

              • selinexor

                selinexor, gold sodium thiomalate. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • tofacitinib

                gold sodium thiomalate, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              Monitor Closely (16)

              • benazepril

                benazepril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • captopril

                captopril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • cholera vaccine

                gold sodium thiomalate decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • enalapril

                enalapril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • fosinopril

                fosinopril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • imidapril

                imidapril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • lisinopril

                lisinopril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • meningococcal group B vaccine

                gold sodium thiomalate decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

              • moexipril

                moexipril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • ofatumumab SC

                ofatumumab SC, gold sodium thiomalate. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • olaparib

                gold sodium thiomalate and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

              • perindopril

                perindopril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • quinapril

                quinapril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • ramipril

                ramipril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              • sipuleucel-T

                gold sodium thiomalate decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              • trandolapril

                trandolapril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

              Minor (0)

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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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                Images

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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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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.