Gold Sodium Thiomalate Brand Name– Myochrysine
What is Gold Sodium Thiomalate
Gold sodium thiomalate is a parenteral disease-modifying antirheumatic drug (DMARD) used to treat early, active cases of rheumatoid arthritis (RA) or juvenile rheumatoid arthritis (JRA).
Gold sodium thiomalate is less effective against advanced, chronic cases of RA, as it does not reverse prior structural deformities from the disease.
Initiation of a DMARD within 3 months of RA diagnosis is recommended. Periodic assessment of disease activity is advised; months of therapy may be required to achieve full therapeutic response.
If ongoing, active disease is present after 3 months of maximal therapy, addition of another DMARD or initiation of a different DMARD is recommended in methotrexate-naive patients.
Addition of another DMARD, initiation of a different DMARD, or initiation of a biologic is recommended for patients with a suboptimal response to methotrexate.
Rheumatoid arthritis originally was believed to be caused by an infectious agent and because gold exhibited antimicrobial activity, attempts to treat RA with gold compounds were initiated in the late 1920s.
Somewhat favorable results were obtained (although probably not due to the drug’s antimicrobial properties), and the clinical efficacy of gold preparations in the treatment of rheumatoid arthritis was accepted in 1961.
Gold sodium thiomalate was approved for clinical use by the FDA before 1962.
Indications
- juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
- rheumatoid arthritis
Side Effects
- abdominal pain
- alopecia
- anaphylactic shock
- anemia
- angioedema
- anorexia
- aplastic anemia
- arthralgia
- bleeding
- bradycardia
- chest pain (unspecified)
- cholestasis
- confusion
- conjunctivitis
- cough
- diaphoresis
- diarrhea
- dizziness
- dysgeusia
- dyspnea
- ecchymosis
- enterocolitis
- eosinophilia
- exfoliative dermatitis
- fever
- flushing
- GI bleeding
- gingivitis
- glomerulonephritis
- glossitis
- gold toxicity
- hallucinations
- headache
- hematuria
- hepatitis
- hypotension
- interstitial nephritis
- iritis
- jaundice
- leukopenia
- malaise
- metallic taste
- nausea
- nephrotic syndrome
- nephrotoxicity
- oral ulceration
- peripheral neuropathy
- pneumonitis
- proteinuria
- pruritus
- pulmonary fibrosis
- purpura
- rash
- seizures
- sinus tachycardia
- stomatitis
- syncope
- thrombocytopenia
- vomiting
- weakness
- wheezing
Monitoring Parameters
- CBC with differential
- urinalysis
Contraindications
- agranulocytosis
- anemia
- anticoagulant therapy
- benzyl alcohol hypersensitivity
- bleeding
- bone marrow suppression
- breast-feeding
- coagulopathy
- diabetes mellitus
- diarrhea
- exfoliative dermatitis
- gold toxicity
- heart failure
- hematuria
- hemophilia
- hepatic disease
- hypertension
- inflammatory bowel disease
- intravenous administration
- leukopenia
- necrotizing enterocolitis
- neutropenia
- pregnancy
- proteinuria
- pulmonary fibrosis
- renal disease
- renal failure
- renal impairment
- requires an experienced clinician
- serious rash
- stomatitis
- sunlight (UV) exposure
- systemic lupus erythematosus (SLE)
- thrombocytopenia
Interactions
- Amikacin
- Aminoglycosides
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
- Amphotericin B liposomal (LAmB)
- Angiotensin-converting enzyme inhibitors
- Benazepril
- Benazepril; Hydrochlorothiazide, HCTZ
- Captopril
- Captopril; Hydrochlorothiazide, HCTZ
- Celecoxib
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Dimercaprol
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Enalapril, Enalaprilat
- Enalapril; Felodipine
- Enalapril; Hydrochlorothiazide, HCTZ
- Esomeprazole; Naproxen
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Flurbiprofen
- Foscarnet
- Fosinopril
- Fosinopril; Hydrochlorothiazide, HCTZ
- Gentamicin
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrocodone; Ibuprofen
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Kanamycin
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Lisinopril
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Moexipril
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nonsteroidal antiinflammatory drugs
- Oxaprozin
- Paromomycin
- Penicillamine
- Perindopril
- Perindopril; Amlodipine
- Piroxicam
- Plazomicin
- Quinapril
- Ramipril
- Rituximab
- Rituximab; Hyaluronidase
- Rofecoxib
- Streptomycin
- Sulindac
- Tobramycin
- Tolmetin
- Trandolapril
- Trandolapril; Verapamil
- Valdecoxib
- Vancomycin
