Gold Sodium Thiomalate

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

  1. abdominal pain
  2. alopecia
  3. anaphylactic shock
  4. anemia
  5. angioedema
  6. anorexia
  7. aplastic anemia
  8. arthralgia
  9. bleeding
  10. bradycardia
  11. chest pain (unspecified)
  12. cholestasis
  13. confusion
  14. conjunctivitis
  15. cough
  16. diaphoresis
  17. diarrhea
  18. dizziness
  19. dysgeusia
  20. dyspnea
  21. ecchymosis
  22. enterocolitis
  23. eosinophilia
  24. exfoliative dermatitis
  25. fever
  26. flushing
  27. GI bleeding
  28. gingivitis
  29. glomerulonephritis
  30. glossitis
  31. gold toxicity
  32. hallucinations
  33. headache
  34. hematuria
  35. hepatitis
  36. hypotension
  37. interstitial nephritis
  38. iritis
  39. jaundice
  40. leukopenia
  41. malaise
  42. metallic taste
  43. nausea
  44. nephrotic syndrome
  45. nephrotoxicity
  46. oral ulceration
  47. peripheral neuropathy
  48. pneumonitis
  49. proteinuria
  50. pruritus
  51. pulmonary fibrosis
  52. purpura
  53. rash
  54. seizures
  55. sinus tachycardia
  56. stomatitis
  57. syncope
  58. thrombocytopenia
  59. vomiting
  60. weakness
  61. 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
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