Auranofin
Synonym :
Gold Salts
Mechanism :
It is a gold salt used as an immunomodulator in the treatment of active rheumatoid arthritis or psoriatic arthritis.
Indication :
- Juvenile Idiopathic Arthritis (off-label)
Contraindications :
Auranofin is contraindicated in patients with a history of any of the gold-induced disorders LIKE anaphylactic reactions, necrotizing enterocolitis, pulmonary fibrosis, exfoliative dermatitis, bone marrow aplasia or other severe hematologic disorders.
Dosing :
Initially 0.1 mg/kg/day (Oral) dose in 1-2 divided doses daily. Maintenance: 0.15 mg/kg/day (Oral) divided into 1-2 divided doses with a maximum dose of 0.2 mg/kg/day administered in a single dose or equally divided doses 12 hours apart.
Adverse Effect :
Diarrhoea, rash, abdominal pain, pruritus, leukopenia, thrombocytopenia, skin rash, stomatitis, nausea, anorexia, dyspepsia, flatulence, proteinuria, alopecia, anemia, peripheral neuropathy, interstitial pneumonitis.
Interaction :
The concurrent use of auranofin and phenytoin, an antiepileptic drug, may increase phenytoin blood levels, which may lead to phenytoin toxicity for unclear reasons.
The concurrent use of penicillamine and gold salts may result in blood cell or kidney toxicity since both drugs are toxic to the blood cells and kidney.
Auranofin should not be used with atovaquone/proguanil (Malarone) an antimalarial drug, as the combination may increase the risk of toxicity to blood cells.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
20-50 | 3–6 mg daily |
10-20 | 3 mg daily |
<10 | Avoid |
Dose in Patients undergoing Renal Replacement Therapies
CAPD | Unknown dialysability. Dose as in GFR<10 mL/min |
HD | Not dialysed. Dose as in GFR<10 mL/min |
HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
CAV/VVHD | Not dialysed. Dose as in GFR=10– 20 mL/min |
Hepatic Dose :
Use with caution in patients with hepatic impairment. Specific guidelines for dosage adjustments in hepatic impairment are not available.