Home > Rheumatology > Therapy

IM gold therapy

I.M. Gold, Myocrisin or Sodium Aurothiomalate is indicated for the treatment of active R.A. and some other inflammatory arthropathies. It is normally used 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
Previous Serious Adverse Reaction to Myocrisin

DOSAGE

Test Dose 5 - 10mg I.M.
Maintenance 20 - 50mg weekly
Reduce frequency of injections to every two weeks after 3 months or response to treatment.
Reduce frequency of injections to monthly if response continues.
Stop treatment if total dose of 1000mg reached without response.
Stop treatment if treatment continued for six months without 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 Eosinophil count Platelet count Urinalysis for protein and blood Biochemical Profile	Haemoglobin Total white cell count Neutrophil count Eosinophil 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
Eosinophilia	Rising trend	Reduce dose: may warn of adverse event e.g. rash.
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.
Malaise, increased stiffness	Continue drug, reduce dose if necessary, usually settles as treatment continues.
Nitroid reaction (hypotension, flushing, nausea)	STOP Drug, re-introduce at lower dose if not severe.
Dyspnoea	Pulmonary complications are rare but potentially serious, seek advice.
Visual Disturbance	STOP drug Can be deposits of drug in lens, seek advice.
Alopecia	STOP drug if severe.

IM Gold flow chart
IM Gold patient advice leaflet

Source: Dr PR Crook, Consultant Rheumatologist.

Brad Cheek:

Brad Cheek: last updated Dec 2006
Home
Doctors
Training
IT
Links
Latest
Search