gold sodium thiomalate; aurothiomalate

Gold sodium thiomalate is a gold-containing chemical (salt) used in treatingrheumatoid arthritis. Other gold salts available include injectableaurothioglucose(Solganal) and oralauranofin(Ridaura). It is not well understood exactly how gold salts work. In patients with inflammatoryarthritis, such as adult andjuvenile 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 antiinflammatorydrugsthat 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 (NSAIDsandcorticosteroids) 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 brand names are available for aurothiomalate?

Myochrysine

Is aurothiomalate available as a generic drug?

GENERIC AVAILABLE: No

Do I need a prescription for aurothiomalate?

Yes

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.

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.

The concurrent use ofpenicillamine(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),一个抗疟药物,如相结合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, andhypotensionor seriouslylow blood pressure) may occur when injectable gold (sodium aurothiomalate), used in the treatment ofrheumatoid arthritis, is combined withACE inhibitors, such asenalapril(Vasotec),lisinoprilCozaar),captopril(Capoten),ramipril(Altace) and others.

There are no adequate studies inpregnantwomen. Gold sodium thiomalate should be used duringpregnancyonly if the benefit to the mother justifies the potential risk to the fetus.

Gold sodium thiomalate has been found in the母乳ofnursingmothers. Due to the potential for serious adverse reactions in nursing infants, decisions should be made whether to discontinue nursing or to discontinue the drug.

What preparations of aurothiomalate are available?

Injectable solution: 25 and 50 mg/ml.

How should I keep aurothiomalate stored?

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