Gold Compound (Oral parenteral)

Gold compounds are used as a part of active rheumatoid arthritis complete treatment program. They are used alongside other non- medicine therapies like physical therapies and rest.

Overview

Gold compounds help rheumatoid arthritis patients to recover well, especially those who have not responded to other drugs. They are not pain relievers, but they reduce the inflammation that causes arthritis pain. These drugs are administered to the body orally (use of capsules) or by intramuscular injections.

Just like the other medications, gold compounds may cause unwanted effects like nausea, diarrhea, and vomiting. Most of the effects tend to stop after a while as the body gets used to the drug. Patience is however required while taking gold compounds since most of the positive changes start showing after three or four months. However, it should not take more than six months. For the medication to be beneficial, patients are advised to take the drugs to completion and avoid skipping doses.

Conditions Treated

  • Adult rheumatic arthritis
  • Juvenile arthritis

Type Of Medicine

  • Antirheumatic

Side Effects

Along with the gold compounds' needed effects, the drugs may cause other unwanted effects. This medication has been reported to cause kidney cancer and tumors when given to animals for an extended period and in large amounts. However, similar human cases have not been reported, but its intake should be handled with caution. Check with your healthcare provider if you have any questions about this. Check with your doctor as soon as possible if any of the following side effects occur:

The most common side effects caused by gold compounds are skin rashes or itching, soreness and irritation of tongue, metallic taste, sores, and ulcers, bleeding and swelling of gums, throat, and lips. Some patients have also been reported to have cloudy or bloody urine, hives, convulsions, confusion, abdominal or stomach cramping, pain, severe burning, and black or bloody tarry stools. These effects may be severe and last longer in some patients than others. It is therefore essential to check with your doctor if the effects persist.

Gold compounds may sometimes cause other effects although their occurrence is rare. Cases of patients having dark urine, hair loss, decreased vision, and decreased urination, difficulty swallowing and feeling of an object in the eye have been reported. Some patients also experience hallucinations, vagina irritation and shortness of breath. These effects should not be ignored. By seeking medical assistance, the doctor may decide to change the intake of the drug or discontinue it.

Other minor effects like fever, nose irritation with coughing and hoarseness, wheezing, fever, vomiting and nausea, heartburn, numbness, pain, tingling or weakness in the arms, face, feet or hands may be experienced immediately or shortly after taking the medication. These effects are expected to stop after a while as the body continues adjusting itself to the drug. However, it's important to seek medical help if they keep showing up every time you take the medicine.

Gold compounds can also cause other worth mentioning effects that may be bothersome to the patient although they don't often occur. For example, some patients get pale stools, pain in the lower abdomen and the lower back, painful urination, pinpoint red or black spots on your skin, scaly or thickened skin or muscle coordination problems. Gold compounds can also cause swollen or painful glands, fever and sore throat with chills, unusual bruising or bleeding, unusual weakness and tiredness, swollen lips, eyelids and tongue as well as vomiting blood or substances that look like coffee grounds. Also, if your skin or eyes turn yellow, check with your doctor immediately.

Most of the common effects do not require medical attention. Your healthcare provider may give you some tips or advice on what to do to reduce the effects. Auranofin can cause loss of or decreased appetite, loose stools, and diarrhea, mild vomiting, and diarrhea, constipation or joint pains. Some patients notice a change in taste of some foods and drinks. If you start feeling a metallic taste in your mouth while still under gold compound medication, it is crucial to make a point of seeing your doctor for advice. If you notice other taste changes, it might not be essential to consult your doctor unless it becomes bothersome.

Other effects that are not mentioned here may still occur. Always check with your doctor when you have any question about the drug.

Dosage

Gold compound must be regularly taken as per the doctor's orders for it to work for the patient well. The most common used gold compounds are Auranofin and Gold Sodium Thiomalate. The dosage must be completed even when the drug seems not to be working. This is because gold compound effects may start showing positive effects after 3 to 6 months of continuous use. Also, the medicine should not be taken in a higher dosage other than the instructed one. Using too much gold compound increases the chances of getting unwanted effects.

The dosage differs in every patient hence the instructions labeled must be well followed. The information given here shows the average dosage of the drug. If you are given a different dose, follow it unless your healthcare provider instructs you otherwise. The medication amount depends on the period that you will be taking the drug, the strength of the drug, the number of daily doses and the time given between the doses.

Gold compounds are taken in either oral form or parenteral routes like injections.

For Auranofin;

The normal average adult oral dosage (capsules) for arthritis is six milligrams (mg) taken once daily or 3mg taken twice a day. After six months, the dosage may be increased to 3mg taken thrice a day.

For children, the dosage is determined by the healthcare provider.

The normal injection dosage form given for arthritis is:

Adults '10 milligrams (mg) is injected for the initial dose, then 25 mg administered once every week for the following two weeks.

After the two weeks, the dosage can be increased to 25 or 50mg once every week. The injections are done into the muscles. After a few months, the infusions, may be reduced (25 or 50mg to be administered once every two weeks, three or four weeks).

Children aged 6 to 12 years'2.5 mg is injected for the initial dose, then 6.25 mg administered once every week in the following two weeks. After some months, the injections may be reduced to 6.25 or 12.5 mg administered only once after three or four weeks).

Children less than 6 years'”the dose is determined by the healthcare provider.

For the Gold Sodium Thiomalate:

The typical injection dosage for Adults and teenagers is 10mg for the initial dose, then 25 mg administered after one week. In the following 2 or 3 weeks, the dosage is increased to 25 0r 50 mg weekly. After a few months, the infusions may be reduced to 25 or 50 mg administered once every two weeks, then later after every three or four weeks.

The usual dosage for children is 10 mg for the initial dose, followed by 1 mg per kilogram administered once per week depending on the child's weight. The dosage should however not be more than 50mg per week. After a few weeks, the same dosage may be reduced to be given once after every two weeks, three or four weeks.

If you miss an Auranofin dose and you take the gold compound dose once daily, the missed dose should be taken as soon as possible. In case you fail to remember till the following day, do not take it, go back to the regular dosing schedule to avoid double doses. However, if you take more than a single dose per day, you can skip the missed dose to prevent double dosing.

Performed studies have not yet demonstrated any geriatrics problems that can limit the intake of gold compounds in the by the elderly. However, the aged patients are more prone to having age-related impairments like the renal impairment, which may need caution while being getting the gold compound treatment.

Interactions

Most drugs interact with the human body irrespective of their intake route and cause dangerous effects. For this reason, some medications should not be taken together at all. Sometimes, it might be necessary to use different drugs at the same time even if they will cause an interaction. In these cases, the healthcare provider may change the drugs dosage, their intake frequency or use other precautions.

It is very therefore important to inform your doctor when you are using other medicines, vitamin supplements or herbal drugs like ace inhibitors (Lisinopril), medications that suppress immune systems like cancer chemotherapy drugs, or phenytoin and phenylbutazone. Don't forget to mention any of the following medicines; the doctor may either decide not to give you the gold compound or change the other drugs you are using.

  • Halofantrine
  • Chloroquine
  • Hydroxychloroquine
  • Mefloquine
  • Primaquine
  • Penicillamine
  • Proguanil
  • Pyrimethamine
  • Quinine

Some drugs should not be taken together with certain types of food or drugs. This is because interactions may take place. Taking alcohol and tobacco may reduce the effectiveness of gold compounds. It's, therefore, necessary to discuss with your doctor about the use of tobacco and alcohol while on medication.

Gold compounds may sometimes interfere with some laboratory tests like the turbelin skin test and give false results. To be on the safe side, make sure that your laboratory personnel and your doctors know that you are currently under this drug. There could be other possible interactions not mentioned here hence it's imperative to have a record of the medicines you are taking. Let your pharmacist or doctor see the list.

Warnings

There are medical problems that affect the usage of gold compounds. Ensure you inform your doctor if you have any of these medical issues:

  • Blood or blood vessel disease
  • Kidney disease (or history of)
  • Colitis
  • Lupus erythematosus
  • Skin disease and rashes
  • Lung disease
  • Stomach/intestinal problems

Gold compounds can cause allergic reactions. Inform your doctor if you get any allergic reactions after taking the drugs or any of the drug's ingredients. Your healthcare provider may tell you the components of the drug. Also, inform your doctor if you have other allergies like food dyes, animals or preservatives.

Gold compounds make some people sensitive to light and may develop excess rashes when they get exposed to the sun. To those who already have some rashes, the condition could worsen. To protect yourself:

  • Wear protective garments
  • Stay away from direct sunlight as much as possible, especially between 10:00 a.m. and 4:00 p.m.
  • Consult your doctor to know if you can apply any of the sunblock products. The best products are the ones that contain at least 15 skin protection factor (SPF); although a higher dosage of the SFP may be needed for the patients of fair complexion. However, avoid using tanning bed, booth or a sunlamp.
  • Consult your healthcare provider immediately if you develop severe sun reactions like skin blisters.

Gold compounds may cause immediate side effects like vomiting and nausea, dizziness, redness or flushing in the face, unusual weakness or increased sweating. Usually, the effects go away once the patient takes a rest. If the effects become severe or take longer than expected, check with your doctor immediately. Some patients experience joint pains 24 to 48 hours after getting the dose. The effects should disappear within the first week. However, if it continues to be bothersome, inform your healthcare provider immediately.

Before you use the gold compound medicine, tell your pharmacist or doctor about your medical history especially if you have high blood pressure, liver disease, stroke-specific lung problems like fibrosis, heart problems like congestive heart failure and heart attack. The doctor should also be made aware of diabetes, eczema, chest pains, recent radiation therapy, inflammatory/ colitis bowel.

The thrombocytopenic and leukopenic gold compound effects may result in increased cases of microbial infection, gingival bleeding and delayed healing. If thrombocytopenia or leucopenia occurs, the dental work should first be deferred until the blood counts go back to normal. The patient needs to be well instructed on proper dental and oral hygiene including dental floss, toothpicks and the correct use of regular toothbrushes. Gold compounds may cause gingivitis, glossitis, and stomatitis.

This medication is not safe for use during pregnancy as may be harmful to the unborn child. It is also passed through breast milk by nursing mothers and can cause undesirable effects on the child. It is therefore advisable to inform the doctor if you are pregnant or planning on becoming pregnant as well as if you are breastfeeding.

You may have to pay regular visits to the hospital for routine checkups. These visits will enable your doctor to carry out urine and blood tests needed to be sure that the gold compound does not cause unwanted effects.

Storage

The medication should be stored at room temperature between 15° and 30°C (59° and 86°F). Dispense it in a tightly closed container away from heat, direct sunlight, and moisture. Do not freeze. Discard the containers well after use as well as the expired and unneeded medicine.

Summary

Gold compounds are indicated for the management of rheumatoid arthritis who are intolerant to, or who have shown no positive response to nonsteroidal anti-inflammatory medicines. They act as a part of a comprehensive program that includes the non-medicine therapies. Unlike the anti-inflammatory medications, gold compounds do not have an immediate response. It might take three or four months of regular treatment for the patient to start showing improvement. In other patients, the recovery is seen at six months.

Patients diagnosed with the early stage of arthritis benefit the most from these drugs because gold does not reverse the structural damage of the joints. The dosage can be administered to the body by oral means or parenteral (like intramuscular injections). The effectiveness of this medication is affected by the presence of other medical problems like kidney, liver and skin disease. Also, the drugs do not work well with Penicillamine. The patient should, therefore, reveal the medications they are currently taking as well as other conditions they may be suffering from. This reduces the risks of having adverse reactions.

Gold compounds should only be taken as per the doctor's prescription. The standard gold compounds dosage for adults is 6mg administered once per day which can also be divided to 3mg and taken twice daily. However, the dosage is given depending on some factors hence it differs in different patients. The common side effects experienced after taking the drug are nausea and vomiting which do not last for long. Other adverse side effects like unusual bleeding have been reported. Patients are advised to seek medical help immediately if the effects become bothersome. For a gold compound drug to be beneficial, regular intake should be observed for the indicated dosage intake period.