No

Gold Compound

Adjunctive treatment in adult and juvenile active rheumatoid arthritis; alternative or adjunct in treatment of pemphigus; psoriatic patients who do not respond to NSAIDs

C

Renal disease, history of blood dyscrasias, congestive heart failure, exfoliative dermatitis, hepatic disease, SLE, history of hypersensitivity

Use with caution in patients with impaired renal or hepatic function; NSAIDs and corticosteroids may be discontinued over time after initiating gold therapy; explain the possibility of adverse reactions before initiating therapy; pregnancy should be ruled out before therapy is started; therapy should be discontinued if platelet counts fall to <100,000/mm³, WBC <4000/mm³, granulocytes <1500/mm³

>10%:

Dermatologic: Itching, rash, exfoliative dermatitis, reddened skin

Gastrointestinal: Gingivitis, glossitis, metallic taste, stomatitis

1% to 10%: Renal: Proteinuria

<1%: Encephalitis, EEG abnormalities, fever, alopecia, ulcerative enterocolitis, vaginitis, agranulocytosis, aplastic anemia, eosinophilia, leukopenia, thrombocytopenia, hepatotoxicity, pharyngitis, bronchitis, pulmonary fibrosis, interstitial pneumonitis, peripheral neuropathy, conjunctivitis, corneal ulcers, iritis, glomerulitis, hematuria, nephrotic syndrome, anaphylactic shock, allergic reaction (severe)

Symptoms of overdose include hematuria, proteinuria, fever, nausea, vomiting, diarrhea; signs of gold toxicity include decrease in hemoglobin, leukopenia, granulocytes and platelets; proteinuria, hematuria, pruritus, stomatitis, persistent diarrhea, rash, or metallic taste; advise patients to report any symptoms of toxicity.

For mild gold poisoning, dimercaprol 2.5 mg/kg 4 times/day for 2 days or for more severe forms of gold intoxication, dimercaprol 3-5 mg/kg every 4 hours for 2 days, should be initiated; then after 2 days the initial dose should be repeated twice daily on the third day, and once daily thereafter for 10 days; other chelating agents have been used with some success

Increased toxicity: Penicillamine, antimalarials, hydroxychloroquine, cytotoxic agents, immunosuppressants

Protect from light and store at 15°C to 30°C

Unknown, may decrease prostaglandin synthesis or may alter cellular mechanisms by inhibiting sulfhydryl systems

Absorption: I.M.: Erratic and slow

Distribution: Crosses placenta; appears in breast milk

Protein binding: 95% to 99%

Half-life: 3-27 days (half-life dependent upon single or multiple dosing)

Time to peak serum concentration: Within 4-6 hours

Elimination: 70% renal excretion; 30% fecal

I.M.: Doses should initially be given at weekly intervals

Adults: 10 mg first week; 25 mg second and third week; then 50 mg/week until 800 mg to 1 g cumulative dose has been given; if improvement occurs without adverse reactions, administer 25-50 mg every 2-3 weeks, then every 3-4 weeks

I.M. only, preferably intragluteally

CBC with differential, platelet count, urinalysis, baseline renal and liver function tests

Gold: Normal: 0-0.1 mg/mL (SI: 0-0.0064 mmol/L); Therapeutic: 1-3 mg/mL (SI: 0.06-0.18 mmol/L); Urine: <0.1 mg/24 hours

None reported

May rarely produce agranulocytosis; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

Minimize exposure to sunlight; benefits from drug therapy may take as long as 3 months to appear; notify physician of pruritus, rash, sore mouth; metallic taste may occur

Therapy should be discontinued if platelet count falls <100,000/mm³; vial should be thoroughly shaken before withdrawing a dose; explain the possibility of adverse reactions before initiating therapy; advise patients to report any symptoms of toxicity

Injection, suspension: 50 mg/mL [gold 50%] (10 mL)