Medications and Drugs

Rheumatoid Arthritis Slideshow Rheumatoid Arthritis Exercises Slideshow

Pharmacy Author: Annette Gbemudu-Ogbru, PharmD, MBA
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: auranofin

BRAND NAME: Ridaura

DRUG CLASS AND MECHANISM: Auranofin is an oral, gold-containing chemical (salt) used for treating rheumatoid arthritis. Other gold salts available are injectable and include aurothioglucose (Solganal) and gold sodium thiomalate (Myochrysine). 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 lining of the joint. They prevent the inflammation from destroying the bone and cartilage surrounding the joint and deformities of the joints. Because of its ability to prevent or slow deformities of the joints, auranofin is considered a disease modifying anti-rheumatic drug (DMARD). Gold salts also are called second-line drugs because they often are considered when arthritis persists in spite of the use of antiinflammatory drugs (NSAIDs and corticosteroids). The term second-line is misleading since anti-inflammatory drugs and DMARDs have different mechanisms of action and in general are used together for their additive effects. DMARDs may take weeks to months to become effective. Auranofin was FDA approved in May 1985.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Capsule: 3 mg.

STORAGE: Auranofin should be store between 15 and 30 C (59 and 86 F) and dispensed in a tight, light-resistant container

PRESCRIBED FOR: Auranofin is used in the treatment of active, progressive or destructive forms of inflammatory arthritis, such as rheumatoid arthritis. Off label uses include Felty's Syndrome (a rare disorder that includes rheumatoid arthritis, a swollen spleen, and decreased white blood cell count), psoriatic arthritis and juvenile rheumatoid arthritis.

DOSING: The usual adult dosage of auranofin is 3 mg twice daily.

DRUG INTERACTIONS: The concurrent use of auranofin and phenytoin (Dilantin), an antiepileptic drug, may increase phenytoin blood levels, which may lead to phenytoin toxicity for unclear reasons. The concurrent use of penicillamine (Cuprimine, Depen) and gold salts may result in blood cell or kidney toxicity since both drugs are toxic to the blood cells and kidney. The auranofin should not be used with atovaquone/proguanil (Malarone) an antimalarial drug, as the combination may increase the risk of toxicity to blood cells.

PREGNANCY: There are no adequate studies in pregnant women. Use of auranofin in pregnant women is not recommended.

NURSING MOTHERS: Auranofin has been found in the breast milk of nursing mothers. Nursing during auranofin therapy is not recommended.

SIDE EFFECTS: The most common side effect of auranofin is loose stools or diarrhea. Another side effect is inflamed skin; an itching sensation can be an early warning sign of a skin reaction, such as a rash. Auranofin also can cause a metallic taste and mouth sores, though less frequently than injectable gold salts. Because gold salts can cause serious kidney and bone marrow problems, all patients require monitoring with regular testing of blood and urine.

Reference: FDA Prescribing Information

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