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- What is aurothiomalate, and how does it work (mechanism of action)?
- What brand names are available for aurothiomalate?
- Is aurothiomalate available as a generic drug?
- Do I need a prescription for aurothiomalate?
- What are the side effects of aurothiomalate?
- What is the dosage for aurothiomalate?
- Which drugs or supplements interact with aurothiomalate?
- Is aurothiomalate safe to take if I'm pregnant or breastfeeding?
- What else should I know about aurothiomalate?
What is aurothiomalate, and how does it work (mechanism of action)?
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.
What are the side effects of aurothiomalate?
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.
What is the dosage for aurothiomalate?
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.
Which drugs or supplements interact with aurothiomalate?
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.
Is aurothiomalate safe to take if I'm pregnant or breastfeeding?
There are no adequate studies in pregnant women. Gold sodium thiomalate should be used during pregnancy only if the benefit to the mother justifies the potential risk to the fetus.
Gold sodium thiomalate has been found in the breast milk of nursing mothers. Due to the potential for serious adverse reactions in nursing infants, decisions should be made whether to discontinue nursing or to discontinue the drug.
Gold sodium thiomalate; aurothiomalate (Myochrysine) is a drug prescribed for the treatment of adult and juvenile rheumatoid arthritis, psoriatic arthritis, and Felty's syndrome. Side effects, drug interactions, warnings and precautions, and patient information should be reviewed prior to taking any medication.
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