Nurses Compass
Drug Guide
Auranofin
Classification
Therapeutic: Disease-modifying antirheumatic drug (DMARD)
Pharmacological: Gold compound
FDA Approved Indications
- Rheumatoid arthritis (moderate to severe case)
Mechanism of Action
Auranofin inhibits enzyme activity in immune cells, decreasing inflammation and immune response in rheumatoid arthritis. It interferes with lysosomal functions and reduces leukocyte activity.
Dosage and Administration
Adult: Initially 6 mg orally once daily; dosage may be adjusted based on response and tolerance.
Pediatric: Not typically used in pediatric patients.
Geriatric: Use with caution due to potential renal or hepatic impairment; start at lower dose and adjust carefully.
Renal Impairment: Adjust dosage based on renal function; specific guidelines not well established.
Hepatic Impairment: Use with caution; monitor liver function.
Pharmacokinetics
Absorption: Orally absorbed, with peak plasma levels in 1-2 hours.
Distribution: Widely distributed, binds to serum proteins.
Metabolism: Metabolized minimally; major form excreted unchanged.
Excretion: Primarily via urine; some via feces.
Half Life: Approximately 35 days, allowing for long-term treatment with once-daily dosing.
Contraindications
- Hypersensitivity to gold compounds
- Pregnancy (Category D)
Precautions
- Monitoring for allergic reactions, blood dyscrasias, renal or hepatic toxicity. Use cautiously in patients with prior gold allergy or renal impairment.
Adverse Reactions - Common
- Rash (Common)
- Diarrhea (Common)
- Gastritis or stomatitis (Common)
Adverse Reactions - Serious
- Blood dyscrasias (aplastic anemia, thrombocytopenia) (Serious / Rare)
- Nephrotoxicity (Serious / Rare)
- Hepatotoxicity (Serious / Rare)
- Dermatitis or allergic reactions (Serious / Rare)
Drug-Drug Interactions
- Other immunosuppressants
- Nephrotoxic drugs
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Baseline renal, hepatic function, blood counts, and signs of gold allergy.
Diagnoses:
- Risk for blood dyscrasias
- Risk for renal or hepatic impairment
Implementation: Administer orally once daily. Educate patient on side effects and medication adherence.
Evaluation: Monitor blood counts, kidney and liver function regularly, assess for adverse reactions.
Patient/Family Teaching
- Report any signs of skin rash, sore throat, fever, bleeding, or fatigue.
- Take medication exactly as prescribed.
- Inform about possible side effects including mouth ulcers, diarrhea, or allergic reactions.
Special Considerations
Black Box Warnings:
- Potential for serious blood dyscrasias and anaphylactic reactions.
Genetic Factors: Not well characterized.
Lab Test Interference: Gold compounds can interfere with certain lab tests; inform laboratory personnel.
Overdose Management
Signs/Symptoms: Gastrointestinal symptoms, hypersensitivity reactions, blood dyscrasias.
Treatment: Supportive care; chelation therapy if severe overdose suspected; consult poison control.
Storage and Handling
Storage: Store at room temperature, away from moisture and light.
Stability: Stable under recommended storage conditions.