auranofin (Rx)

Brand and Other Names:Ridaura
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 3mg

Rheumatoid Arthritis

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

6 mg PO qDay or divided BID; may increase to 9 mg/day divided TID after 3 months; if no response after 3 months, discontinue drug

Dosage Forms & Strengths

capsule

  • 3mg

Juvenile Idiopathic Arthritis (Off-label)

Data are limited

0.1 mg/kg/day PO in divided doses

Maintenance: 0.15 mg/kg PO qDay or divided BID; not to exceed 0.2 mg/kg/day PO qDay divided BID

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Interactions

Interaction Checker

and auranofin

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (6)

              • influenza virus vaccine quadrivalent, adjuvanted

                auranofin 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

                auranofin 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.

              • pexidartinib

                auranofin and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

              • pretomanid

                auranofin, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

              • selinexor

                selinexor, auranofin. 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

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

              Monitor Closely (6)

              • cholera vaccine

                auranofin 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.

              • meningococcal group B vaccine

                auranofin 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.

              • ocrelizumab

                auranofin and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with high doses of corticosteroids is expected to increase the risk of immunosuppression.

              • ofatumumab SC

                ofatumumab SC, auranofin. 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

                auranofin 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.

              • sipuleucel-T

                auranofin decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              Minor (3)

              • ethotoin

                auranofin increases levels of ethotoin by unspecified interaction mechanism. Minor/Significance Unknown.

              • fosphenytoin

                auranofin increases levels of fosphenytoin by unspecified interaction mechanism. Minor/Significance Unknown.

              • phenytoin

                auranofin increases levels of phenytoin by unspecified interaction mechanism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Diarrhea (47%)

              Rash (24%)

              Pruritus (17%)

              Abd pain (14%)

              Stomatitis (13%)

              1-10%

              Nausea (10%)

              Anorexia (3-9%)

              Conjunctivitis (3-9%)

              Dyspepsia (3-9%)

              Flatulence (3-9%)

              Proteinuria (3-9%)

              Alopecia (1-3%)

              Anemia (1-3%)

              Constipation (1-3%)

              Eosinophilia (1-3%)

              Elevated liver enzymes (1-3%)

              Glossitis (1-3%)

              Hematuria (1-3%)

              Leukopenia (1-3%)

              Thrombocytopenia (1-3%)

              Urticaria (1-3%)

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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/cu.mm, granulocytes <1,500/cu.mm, platelets <150,000/cu.mm, 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

              Pts who have had previous gold-induced disorders (anaphylaxis, necrotizing enterocolitis, pulmonary fibrosis, dermatitis, bone marrow suppression, or other hematologic disorder)

              Cautions

              Not to be used as the sole agent in treatment of RA

              No evidence that gold compounds induce remission of RA

              Gold toxicity

              • Hemoglobin (decreased)
              • 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
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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

              Pharmacokinetics

              Peak plasma time: 2 hr

              Peak plasma concentration: 0.025 mcg/mL

              Onset of effects: 3-6 months

              Half-life: 21-31 days

              Protein bound: 60%

              Excretion: 50% urine; feces

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Ridaura oral
              -
              3 mg capsule

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              auranofin oral

              AURANOFIN - ORAL

              (aw-RAN-o-fin)

              COMMON BRAND NAME(S): Ridaura

              WARNING: This medication can cause serious (sometimes fatal) side effects, including blood cell problems (e.g., anemia, low white blood cells/platelets), kidney problems, rash, itching, mouth sores/irritation (stomatitis), or persistent diarrhea. Low white blood cells can increase your risk of infection. See Side Effects section for more details. Tell your doctor right away if you develop any of these side effects.Your doctor will be closely monitoring certain lab tests (such as white blood cells, platelets) before you start taking this medication and while you are taking it. It is important that you keep all medical/lab appointments.

              USES: This medication is used as part of a complete treatment program including non-drug therapies (e.g., rest, physical therapy) to treat active rheumatoid arthritis. It is used to treat patients with severe rheumatoid arthritis who have not responded to or cannot take other medications. Auranofin is a gold compound.Auranofin is not a true pain reliever (e.g., like aspirin) but it is thought to decrease pain that occurs with arthritis by decreasing inflammation. It is known as a disease-modifying antirheumatic drug (DMARD). It decreases morning stiffness and pain/swelling in joints and can increase grip strength.

              HOW TO USE: This medicine comes with a Patient Information Leaflet. Read it carefully. Ask your doctor, nurse, or pharmacist if you have any questions.Take this medication by mouth, usually once or twice a day with or without food or as directed by your doctor. Dosage is based on your medical condition and response to therapy. To decrease side effects such as upset stomach, your doctor may start you at a low dose (once a day) and slowly increase to twice a day. Do not increase your dose or take this medication more often without your doctor's approval. Your condition will not improve any faster, and the risk of serious side effects may be increased. The usual maximum adult dose is 9 milligrams each day.Almost half of all patients have diarrhea or more frequent/loose stools while taking this medication. If this persists or becomes a problem, your doctor may lower the dose or have you temporarily stop the medication. Do not stop or change the dose of your medicine without talking with your doctor.Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day.If you have been receiving gold injections, you can usually start taking gold by mouth as soon as you stop the injections. If you are changing over from penicillamine, you will usually need to wait 1 month after stopping the penicillamine before starting auranofin. Ask your doctor for more details.It may take 3 to 4 months of therapy before you see the full benefits of this medication.Inform your doctor if your condition persists or worsens.

              SIDE EFFECTS: See also How to Use section.Stomach/abdominal cramping may occur, usually within the first several hours after taking this medication. Nausea, loss of appetite, heartburn, and headache may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: eye redness/pain, hair loss, numbness/tingling of arms/legs.This medication may cause mouth/lip/throat sores (stomatitis). Tell your doctor if you notice a metallic taste in your mouth. This could be the first sign of stomatitis. Rinsing your mouth with a mild salt solution may provide some relief. Discuss with your doctor.Tell your doctor right away if any of these rare but very serious side effects occur: signs of low blood count (e.g., fast/pounding heartbeat, pale skin, unusual tiredness), easy bleeding/bruising, black/bloody stools, persistent cough, mucus/pus/blood in watery diarrhea, difficult/painful breathing, dizziness, signs of infection (e.g., fever, persistent sore throat), severe stomach/abdominal pain, unusual tiredness, change in the amount/color of urine, vomit that looks like coffee grounds, yellowing eyes/skin.A very serious allergic reaction to this drug is uncommon. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: itching/swelling (especially of the face/tongue/throat), rash, severe dizziness, trouble breathing.Skin rash is common with this medication and can be serious. Itching is often the first sign of a severe allergic reaction. Seek immediate medical attention if you develop any rash or itching.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking auranofin, tell your doctor or pharmacist if you are allergic to it; or to any other gold or heavy metal compound; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: history of reaction to gold compound (e.g., blood disorders, kidney problems, lung problems, stomach/intestinal problems).Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, blood disorders (e.g., bone marrow depression), colitis/inflammatory bowel disease, eczema, certain lung problem (fibrosis), kidney disease, liver disease, SLE (systemic lupus erythematosus), recent radiation therapy.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.This medication is not recommended for use during pregnancy. It may harm an unborn baby. If you become pregnant or think you may be pregnant, inform your doctor right away. Consult your doctor for more details.This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.This drug should not be used with the following medication because a very serious interaction may occur: penicillamine.If you are currently using the medication listed above, tell your doctor or pharmacist before starting auranofin.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: phenytoin.This medication may interfere with certain laboratory tests (including tuberculin skin test), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.This document does not contain all possible interactions. Before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., complete blood count, liver/kidney tests, urine tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              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.