gold sodium thiomalate; aurothiomalate, Myochrysine

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GENERIC NAME: gold sodium thiomalate; aurothiomalate

BRAND NAME: Myochrysine

DRUG CLASS AND MECHANISM: Gold sodium thiomalate is a gold-containing chemical (salt) used in treating rheumatoid arthritis. Other gold salts available include injectable aurothioglucose (Solganal) and oral auranofin (Ridaura). It is not well understood exactly how gold salts work. In patients with inflammatory arthritis, such as adult and juvenile rheumatoid arthritis, gold salts decrease the inflammation of the joint lining and also prevent the inflammation from destroying the bone and cartilage surrounding the joint. Because they prevent destruction of joints (in contrast to antiinflammatory drugs that just treat symptoms and signs of arthritis but do not prevent the destruction) gold thiomalate is known as a disease-modifying antirheumatic drug (DMARD). Gold salts also may be referred to as second-line drugs because they are often considered when the arthritis persists in spite of the use of antiinflammatory drugs (NSAIDs and corticosteroids) which are not DMARDs. The term, second line, may be misleading, however, since anti-inflammatory drugs and DMARDs in general should be used together because of their different mechanisms of action and additive effects.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Injectable solution: 25 and 50 mg/ml.

STORAGE: Gold sodium thiomalate should be stored at 20 C to 25 C (68 F to 77 F) and protected from light.

PRESCRIBED FOR: Gold sodium thiomalate is used in the treatment of active, progressive, or destructive forms of inflammatory arthritis, such as adult and juvenile rheumatoid arthritis. Off label (non-FDA approved) uses include Felty's Syndrome (a rare disorder that includes rheumatoid arthritis, a swollen spleen, and decreased numbers of white blood cells) and psoriatic arthritis.

DOSING: The usual initial adult dose is 10 mg by intramuscular injection followed by 25 mg for the second dose, then 25 to 50 mg weekly until gold toxicity or substantial clinical improvement occurs, or a cumulative dose of 1 g has been administered.

The usual dose for children is based on the weight of the child and is proportional to the adult dose. The maximum single dose for children younger than 12 years of age is 50 mg. After an initial test dose of 10 mg, one dosage regimen recommended for children is 1 mg/kg per week.

DRUG INTERACTIONS: The concurrent use of penicillamine (Cuprimine, Depen) and gold sodium thiomalate should be avoided as the combination decreases the levels and efficacy of both drugs due to chelation (binding of the gold salt with penicillamine). Gold sodium thiomalate should not be used in combination with atovaquone/proguanil (Malarone), an antimalarial drug, as the combination may increase the risk of serious blood abnormalities. (Either drug alone may have such effects, but the combination is more likely to cause them, i.e., the toxicity is additive.) Nitritoid reactions (symptoms include facial flushing, nausea, vomiting, and hypotension or seriously low blood pressure) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, such as enalapril (Vasotec), lisinopril Cozaar), captopril (Capoten), ramipril (Altace) and others.




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