No

Gold Compound

Treatment of progressive rheumatoid arthritis

C

Hypersensitivity to gold compounds or any component; systemic lupus erythematosus; history of blood dyscrasias; congestive heart failure, exfoliative dermatitis, colitis

Frequent monitoring of patients for signs and symptoms of toxicity will prevent serious adverse reactions; nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids may be discontinued after initiating gold therapy; must not be injected I.V.

>10%:

Dermatologic: Itching, rash

Gastrointestinal: Stomatitis, gingivitis, glossitis

Ocular: Conjunctivitis

1% to 10%:

Dermatologic: Urticaria, alopecia

Hematologic: Eosinophilia, leukopenia, thrombocytopenia

Renal: Proteinuria, hematuria

<1%: Angioedema, ulcerative enterocolitis, GI hemorrhage, dysphagia, metallic taste, agranulocytosis, anemia, aplastic anemia, hepatotoxicity, peripheral neuropathy, interstitial pneumonitis

Symptoms of overdose include hematuria, proteinuria, fever, nausea, vomiting, diarrhea

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.

Decreased effect with penicillamine, acetylcysteine

Should not be used if solution is darker than pale yellow

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

Onset of effect: Delayed; may require up to 3 months

Half-life: 5 days; may lengthen with multiple doses

Time to peak serum concentration: Within 4-6 hours

Elimination: Majority (60% to 90%) excreted in urine with smaller amounts (10% to 40%) excreted in feces (via bile)

I.M.:

Adults: 10 mg first week; 25 mg second week; then 25-50 mg/week until 1 g cumulative dose has been given; if improvement occurs without adverse reactions, administer 25-50 mg every 2-3 weeks for 2-20 weeks, then every 3-4 weeks indefinitely

Dosing adjustment in renal impairment:

Cl_cr 50-80 mL/minute: Administer 50% of normal dose

Cl_cr <50 mL/minute: Avoid use

Signs and symptoms of gold toxicity, CBC with differential and platelet count, urinalysis

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 hour

None reported

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

This medication can only be administered I.M. Drug effects may not be seen for as long as 3 weeks to 3 months. Metallic taste or mouth sores may occur (frequent mouth care and lozenges may help); gray-blue color or irritation and reddening of skin may occur (avoid excessive exposure to sunlight, use sunscreen, sunglasses, and protective clothing). Report acute headache, fever; chest pain, palpitations, or irregular heartbeat; unusual bruising, blood in mouth, urine, stool, vomitus; persistent fatigue; persistent metallic taste; abdominal cramping, vomiting, diarrhea; sores in mouth; unresolved skin rash or itching. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Explain the possibility of adverse reactions before initiating therapy

Injection: 25 mg/mL (1 mL); 50 mg/mL (1 mL, 2 mL, 10 mL)