Browse the corpus

Dosing adjustment in renal impairment: Cl cr 50-80 mL/minute: Reduce dose to 50% Cl cr <50 mL/minute: Avoid use Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Capsule, oral: Ridaura®: 3 mg [gold 29%] Generic Equivalent Available: U.S. No Stability Store in tight, light-resistant containers at 15°C to 30°C. Use Management of active stage of classic or definite rheumatoid or psoriatic arthritis in patients who do not respond to or tolerate other agents; adjunctive or alternative therapy for pemphigus Medication Safety Issues Sound-alike/look-alike issues: Ridaura® may be confused with Cardura® Adverse Reactions Dermatologic: Alopecia,pruritus, rash, urticaria Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea/loose stools, dysgeusia, dyspepsia, flatulence, glossitis, nausea, stomatitis, vomiting Hematologic: Eosinophilia, leukopenia, thrombocytopenia Hepatic: Transaminases increased Ocular: Conjunctivitis Renal: Hematuria, proteinuria Rare but important or life-threatening: Agranulocytosis, aplastic anemia, angioedema, corneal deposits, dysphagia, enterocolitis (ulcerative), fever, GI hemorrhage, gingivitis, gold bronchitis, hepatotoxicity, interstitial pneumonitis, jaundice, metallic taste, melena, neutropenia, pancytopenia, peripheral neuropathy, pure red cell aplasia.

Note: Exfoliative dermatitis has been reported with other gold compounds. Contraindications Any history of gold-induced disorders including anaphylactoid reactions, necrotizing enterocolitis, exfoliative dermatitis, pulmonary fibrosis, bone marrow aplasia, or other severe hematologic disorders Precautions Use with caution and modify dose in patients with renal impairment Warnings May be associated with significant toxicity involving dermatologic, gastrointestinal, hematologic, pulmonary, renal, and hepatic systems [U.S. Boxed Warning] ; patient education is required; signs of gold toxicity include decrease in hemoglobin, leukocytes, granulocytes, and platelets; therapy should be discontinued if platelet count falls to <100,000/mm 3 , WBC <4000, granulocytes <1500/mm 3 . Dermatitis and lesions of the mucous membranes are common and may be serious; pruritus may precede the early development of a skin reaction; consider alternative therapy in patient with dermatitis. Signs of GI toxicity include persistent diarrhea, stomatitis, and enterocolitis; avoid use in patients with prior inflammatory bowel disease. May be associated with the development of cholestatic jaundice. Consider alternative therapy in patients with hepatic impairment. May be associated with interstitial fibrosis; monitor closely. Renal toxicity ranges from mild proteinuria to nephrotic syndrome. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) There are no known significant interactions. Pregnancy Risk Factor C ( show table ) Pregnancy Implications Adverse events were observed in animal reproduction studies. Monitoring Parameters Baseline and periodic (at least monthly): CBC with differential, platelet count, urinalysis for protein; baseline renal and liver function tests; skin and oral mucosa examinations; specific questioning for symptoms of pruritus, rash, stomatitis, or metallic taste Reference Range Gold: Normal: 0-0.1 mcg/mL (SI: 0-0.0064 micromoles/L); Therapeutic: 1-3 mcg/mL (SI: 0.06-0.18 micromoles/L); Urine <0.1 mcg/24 hours Mechanism of Action Unknown, acts principally via immunomodulating effects and by decreasing lysosomal enzyme release; may alter cellular mechanisms by inhibiting sulfhydryl systems Pharmacodynamics Onset of action: Therapeutic response may not be seen for 3-4 months after start of therapy

Reference Range Gold: Normal: 0-0.1 mcg/mL (SI: 0-0.0064 micromoles/L); Therapeutic: 1-3 mcg/mL (SI: 0.06-0.18 micromoles/L); Urine <0.1 mcg/24 hours Mechanism of Action Unknown, acts principally via immunomodulating effects and by decreasing lysosomal enzyme release; may alter cellular mechanisms by inhibiting sulfhydryl systems Pharmacodynamics Onset of action: Therapeutic response may not be seen for 3-4 months after start of therapy Pharmacokinetics (Adult data unless noted) Absorption: Oral: Only about 20% to 25% of gold in a dose is absorbed Protein binding: 60% Half-life: 21-31 days (half-life dependent upon single or multiple dosing) Time to peak serum concentration: Within 2 hours Elimination: 60% of absorbed gold is eliminated in urine while the remainder is eliminated in feces Patient Information (For additional information see "Auranofin: Patient drug information" ) Notify your physician of pruritus, sore mouth, indigestion, metallic taste; observe careful oral hygiene. May cause photosensitivity reactions (eg, exposure to sunlight may cause severe sunburn, skin rash, redness, or itching); avoid exposure to sunlight and artificial light sources (sunlamps, tanning booth/bed); wear protective clothing, wide-brimmed hats, sunglasses, and lip sunscreen (SPF ≥15); use a sunscreen [broad-spectrum sunscreen or physical sunscreen (preferred) or sunblock with SPF ≥15]; contact physician if reaction occurs. Additional Information Metallic taste may indicate stomatitis Use of UpToDate is subject to the Subscription and License Agreement . Topic 12895 Version 30.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [0504-58.240.98.179-8913731101-S244013.14]