Auranofin (Ridaura) is a gold compound. It was used previously to treat rheumatic conditions like rheumatoid arthritis owing to its anti-inflammatory properties.

Auranofin Uses:

• Rheumatoid arthritis:

  • Used for treatment of adult patients with active stage classic or definite rheumatoid arthritis in patients who fail to respond to or tolerate an adequate trial of full doses of one or more nonsteroidal anti-inflammatory drugs (NSAIDs)

Auranofin Dose in Adults

Auranofin Dose in the treatment of Rheumatoid arthritis:

• • Initial: 6 mg/day orally in 1-2 divided doses; after 6 months may be increased to 9 mg/day in 3 divided doses; therapy should be discontinued if no response after 3 months at 9 mg per 24 hours

Note: Signs of clinical improvement may not be evident until after 3 months of therapy.

Auranofin Dose in Childrens

Auranofin Dose in the treatment of Juvenile idiopathic arthritis:

Note: Reserve for patients who do not tolerate or fail to respond to other therapies.

• Children ≥18 months and Adolescents ≤17 years:

  • Initial: 0.1 to 0.15 mg/kg/per 24 hours orally in 1 to 2 divided doses; usual maintenance: 0.15 mg/kg/per 24 hours in 1 to 2 divided doses; maximum daily dose: 0.2 mg/kg/per 24 hours  or 9 mg/per 24 hours.

Pregnancy Risk Factor C

• Studies on animal reproduction showed negative effects.

Use during breastfeeding:

• Breast milk contains injectable gold salts.
• Manufacturers do not recommend that you breastfeed during therapy.

Auranofin Dose in Kidney Disease:

No dosage adjustments provided in the manufacturer’s labeling. Some clinicians use the following guidelines:

• GFR 51 to 80 mL/minute: Administer half dose.
• GFR ≤50 mL/minute: Use should be avoided.

Auranofin Dose in Liver disease:

No dosage adjustments provided in the manufacturer’s labeling.

Common Side Effects of Auranofin:

• Dermatologic:

  • Skin rash
  • Pruritus

• Gastrointestinal:

  • Diarrhea
  • Loose stools
  • Abdominal pain
  • Stomatitis

Less Common Side Effects of Auranofin:

• Dermatologic:

  • Alopecia
  • Urticaria

• Gastrointestinal:

  • Nausea
  • Vomiting
  • Anorexia
  • Dyspepsia
  • Flatulence
  • Constipation
  • Dysgeusia
  • Glossitis

• Genitourinary:

  • Proteinuria
  • Hematuria

• Hematologic and Oncologic:

  • Anemia
  • Eosinophilia
  • Leukopenia
  • Thrombocytopenia

• Hepatic:

  • Increased serum transaminases

• Ophthalmic:

  • Conjunctivitis

Contraindications to Auranofin:

• The following are some of the history of gold-induced diseases:
  • Anaphylactic reactions
  • Aplasia of bone marrow
  • Severe hemomatologic disorders
  • Exfoliative dermatitis
  • Necrotizing enterocolitis
  • Pulmonary Fibrosis.

Warnings and precautions

• Dermatologic reactions [US Boxed Warning]

  • Pruritus, rash and stomatitis may be signs of gold poisoning.
  • These reactions are common and include stomatitis, dermatitis, and can be severe (including exfoliative dermatologitis).
  • Possible predisposing signs include pruritus, metallic taste, and oral mucous membrane reaction.
  • Stomatitis can manifest as small, shallow ulcers along the buccal membranes, the border of your tongue, the palate, or in the pharynx. Sometimes it can cause diffuse glossitis and gingivitis.
  • Exposure to sunlight can exacerbate the symptoms of gold dermatitis, or cause actinic skin rash.
  • Patients with skin rash should be cautious. The risk of and/or symptoms associated with gold poisoning may increase and may make it more difficult to detect.

• Gastrointestinal effects:[US Boxed Warning]

  • Gold toxicity can cause persistent diarrhea/loose stools and nausea.
  • Dose reduction may improve diarrhea.
  • Avoid using this product if you have inflammatory bowel disease.
  • The risk of and/or symptoms associated with gold toxicity can be increased. It may also be more difficult to detect.
  • It is important to monitor patients for GI bleeding.

• Hematologic effects[US Boxed Warning]

  • The hematologic effects of toxic gold include hemoglobin deficiency, decreased hemoglobin, leukocytes, WBC 4000/mm3, granulocytes (1500/mm3) and decreased platelets (150,000/mm3
  • Avoid bone marrow depression. The risk of and/or symptoms associated with gold poisoning may increase and may make it more difficult to spot.
  • If you notice any signs or symptoms of thrombocytopenia (eg, purpuras, ecchymoses or petechiae), discontinue therapy.

• Hepatic effects

  • Cholestatic jaundice is rare.
  • Attention is required when you have hepatic impairment.
  • The risk of and/or symptoms associated with gold poisoning may increase and may make it more difficult to detect.

• Toxicity in the lungs:

  • Rare reactions, such as interstitial pneumonitis or gold bronchitis can occur; it is worth keeping an eye on them.

• Effects on the renal system: [US Boxed Warning]

  • Renal toxic signs include proteinuria or hematuria (ranging from mild proteinuria, nephrotic syndrome, or glomerulitis proteinuria/hematuria).
  • Avoid using this product if you have renal impairment.
  • The risk of and/or symptoms associated with gold poisoning may increase and may make it more difficult to detect.
  • Stop the therapy immediately if you experience proteinuria or microscopic hemoturia.

Monitoring parameters:

• CBC with differential (at baseline and during therapy)
• Platelet count (at baseline and during therapy)
• Kidney function tests
• Liver function tests
• Urinalysis
• Inspect skin and oral mucosa for skin rash, bruising or oral ulceration/stomatitis.
• Also include specific questions for symptoms such as pruritus, rash, stomatitis or metallic taste.

How to take Auranofin?

Oral:

• Can take without relation to meal; may administer with food if it causes GI upset.

Mechanism of action of Auranofin:

• It is not known what the exact mechanism of gold's action is.
• It causes a decrease of cell proliferation, inhibits collagenase activity, and reduces antibody/cytokine release.

Notice:

• Because of its rapid metabolism, the pharmacokinetics for auranofin are determined based on gold concentrations and not auranofin.

The beginning of action: Delay in the onset of the therapeutic effect; some patients may experience a delay of up to 6 months or even 3-4 months.

TimeProlonged AbsorptionWhen taken orally, almost 25% of the gold is absorbed

Protein binding: 60%

Metabolism: Fast metabolized, intact auranofin is not detectable in blood

Half-life elimination(single dose or multiple dose dependent): 21-31 days

Time to peak, serum: About 120 minutes

ExcretionAlmost 60% of the absorbed gold is excreted through urine and rest in feces

International brand Names of Auranofin:

• Auropan
• Crytion
• Goldar
• Ridaura
• Ridaura Tiltab
• Ridauran

Auranofin Brand Names in Pakistan:

No brands available in Pakistan