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Oral gold therapy

Oral Gold, Auranofin or Ridaura is indicated for the treatment of active R.A. It is normally used together with NSAIDs particularly in the early stages of treatment. Response to treatment cannot be expected before three months and may not occur until after six months of treatment.

CONTRA-INDICATIONS

Pregnancy and lactation
Gross renal, lung, bowel or hepatic disease
Blood dyscrasias

DOSAGE

Starting Dose 3mg oral daily for 4 weeks
Maintenance 3mg twice daily
Dose can be increased to 3mg three times daily if the response is inadequate.
Stop if treatment continued for six months without positive response.
Total duration of treatment - as long as indicated by clinical condition.

MONITORING

Pre-treatment screening and monitoring every 2 weeks for 2 months then every 4 weeks for the duration of treatment.

PRE TREATMENT SCREENING	EACH MONITORING VISIT
Haemoglobin Total white cell count Neutrophil count Platelet count Urinalysis for protein and blood Biochemical Profile	Haemoglobin Total white cell count Neutrophil count Platelet count Urinalysis for protein and blood

ADVERSE EVENTS

LABORATORY EVENTS	VALUES	ACTION
Leucopaenia	< 3.5 x 10 ⁹ /l	STOP + seek advice
Neutropaenia	< 2.5 x 10 ⁹ /l	STOP + seek advice
Thrombocytopaenia	< 150 x 10 ⁹ /l	STOP + seek advice
Sequential falls in WBC or neutrophils	> 10% on 3 occasions	STOP + seek advice
Sequential falls in Platelets	> 10% on 3 occasions	STOP unless falls are from high level e.g. 600, 500, 400 x 10 ³ which are response to treatment
Haematuria	trace or +	Continue Drug
Haematuria	++ or +++	STOP Drug Check MSU Consider other causes Seek advice
Proteinuria	trace or +	Continue Drug
Proteinuria	++ or +++	STOP Drug Check MSU 24 hour urinary protein Seek Advice

CLINICAL ADVERSE EVENTS	MANAGEMENT
Rash	Often non-specific erythematous, dry and itchy. STOP drug if severe. Consider using 1% hydrocortisone and/or anti-histamines. Consider other causes of rash. If mild re-introduce drug when settled.
Mouth Ulcers / Stomatitis	STOP if severe. Reduce dose if mild/moderate. Consider carbenoxalone or Difflam mouth washes. Consider other causes.
Diarrhoea	Reduce dose Add fibre to diet STOP if unacceptable
Nausea	Reduce dose Take with food STOP if unacceptable
Abdominal Pain	Reduce dose Add fibre to diet Consider other causes STOP if unacceptable

Source: Dr P. N. Platt, Consultant Rheumatologist, Freeman Hospital.

Brad Cheek:

Brad Cheek: last updated Dec 2006
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