Auranofin

Should be taken with food.

History of gold-induced disorders, including anaphylaxis, serious rash or exfoliative dermatitis, bone marrow aplasia, necrotising enterocolitis, severe haematologic disorders, or pulmonary fibrosis.

Patient with inflammatory bowel disease, history of blood dyscrasias or bone marrow depression, and skin rash. Hepatic and renal impairment. Pregnancy and lactation.

Significant: Gold toxicity (e.g. decreased haemoglobin, leukocytes [WBC <4000/mm³], granulocytes [<1500/mm³], or decreased platelets -<150,000/mm³]), nephrotic syndrome or glomerulitis with proteinuria and haematuria, pruritus, rash, stomatitis, persistent diarrhoea/loose stools. Rarely, gold bronchitis, interstitial pneumonitis, fibrosis; ulcerative enterocolitis, cholestatic jaundice.
Ear and labyrinth disorders: Conjunctivitis.
Gastrointestinal disorders: Abdominal pain, nausea, dyspepsia, flatulence, dysgeusia.
Investigations: Elevated liver enzymes.
Metabolism and nutrition disorders: Anorexia.

PO: C

Avoid exposure to sunlight or artificial UV light during treatment.

Monitor CBC with differential, platelet count, urinalysis (baseline and monthly during treatment); renal function tests and LFTs (baseline). Assess for signs and symptoms of gastrointestinal bleeding, skin rash, pruritus, bruising, oral ulceration, stomatitis, or metallic taste.

Concomitant use with phenytoin may increase phenytoin blood levels.

Description:
Mechanism of Action: Auranofin, an orally active gold compound, is a disease-modifying anti-rheumatic drug (DMARD) that exhibits anti-inflammatory, antiarthritic, and immunomodulating properties. Its exact mechanism is not fully understood; however, it is presumed to act primarily through immunomodulation and by reducing lysosomal enzyme release. Gold salts decrease antibody and cytokine release, reduce cellular proliferation, and inhibit collagenase.
Onset: Delayed (as long as 6 months).
Duration: Prolonged.
Pharmacokinetics:
Absorption: Incompletely absorbed from the gastrointestinal tract. Time to peak plasma concentration: Approx 2 hours.
Distribution: Penetrates into synovial fluid. Plasma protein binding: 60%.
Metabolism: Rapidly metabolised.
Excretion: Via urine (approx 60% of the absorbed gold); faeces. Elimination half-life: 21-31 days.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 24199313, CID 24199313. https://pubchem.ncbi.nlm.nih.gov/compound/24199313. Accessed Feb. 25, 2025.

Store between 15-30°C. Protect from light.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

M01CB03 - auranofin ; Belongs to the class of gold preparations of antirheumatic agents.

Anon. Auranofin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 09/12/2024.

Auranofin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 09/12/2024.

Auranofin. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/12/2024.

Brayfield A, Cadart C (eds). Auranofin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/12/2024.

Ridaura Capsule (Sebela Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 09/12/2024.