SIDE EFFECTS: The most common adverse reactions to gold sodium thiomalate are:
- dermatitis (skin inflammation),
- pruritus (itching),
- stomatitis (inflammation affecting the structures in the mouth such as cheeks, gums, tongue, lips, throat), and
- serious kidney and bone marrow problems.
Because gold sodium thiomalate can cause bone marrow problems, all patients require regular monitoring with blood and urine tests.
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.
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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