Auranofin: Difference between revisions

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{{drugbox
{{DrugProjectFormSinglePage
| IUPAC_name = gold(+1) cation; 3,4,5-triacetyloxy-6- (acetyloxymethyl) oxane-2-thiolate; triethylphosphanium
|authorTag=<!--Overview-->
| image = Auranofin-2D-skeletal.png
|aOrAn=a
| image2 = Auranofin-3D-balls.png
|hasBlackBoxWarning=Yes
| CAS_number = 34031-32-8
|adverseReactions=<!--Black Box Warning-->
| ATC_prefix = M01
|blackBoxWarningTitle=<span style="color:#FF0000;">ConditionName: </span>
| ATC_suffix = CB03
|blackBoxWarningBody=<i><span style="color:#FF0000;">ConditionName: </span></i>
| ATC_supplemental =  
 
| PubChem = 6333901
* Content
| DrugBank = APRD00808
 
| C=20 | H=35 | Au=1 | O=9 | P=1 | S=1 | charge=+
<!--Adult Indications and Dosage-->
| molecular_weight = 679.493 g/mol
 
| bioavailability =  
<!--FDA-Labeled Indications and Dosage (Adult)-->
| protein_bound =  
|fdaLIADAdult======Condition1=====
| metabolism =
 
| elimination_half-life =
* Dosing Information
| excretion =  
 
| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
:* Dosage
| pregnancy_US = <!-- A / B / C / D / X -->
 
| pregnancy_category =  
=====Condition2=====
| legal_AU = <!-- Unscheduled / S2 / S4 / S8 -->
 
| legal_UK = <!-- GSL / P / POM / CD -->
* Dosing Information
| legal_US = <!-- OTC / Rx-only -->
 
| legal_status =  
:* Dosage
| routes_of_administration =  
 
}}
=====Condition3=====
{{main|Gold salts}}
 
'''Auranofin''' is a [[Gold salts|organogold compound]] classified by the [[World Health Organization]] as an [[antirheumatic agent]].
* Dosing Information
Pharmacotheraputic class:
 
Auranofin is an organogold compound classified by the World Health Organization as an antirheumatic agent
:* Dosage
==Pharmacokinetics==
 
Auranofin is administered orally  25% of the gold in an orally administered dose of auranofin is absorbed from the GI tract. The drug is metabolized rapidly; unchanged auranofin does not appear in the blood following oral administration. Auranofin may undergo rapid deacetylation within the GI mucosa before absorption.
=====Condition4=====
Peak blood gold concentrations of 0.025 mcg/ml are usually obtained within 2 hours following oral administration. Following multiple dosing, steady state is achieved within 8—12 weeks, although 13—16 weeks of therapy may be required in some patients. The mean steady-state gold concentrations in the blood of patients taking auranofin 6 mg daily was 0.68 +/- 0.45 mcg/ml. The mean blood-gold concentrations are proportional to dose, but no correlation between concentrations and either safety or efficacy has been established. Blood gold concentrations are generally higher than serum or plasma gold concentrations because the gold is sequestered with circulating cells. Gold distributes widely throughout the body and is found in the lymph nodes, bone marrow, spleen, adrenals, liver, and kidneys. Auranofin is approximately 60% plasma protein-bound, and gold appears to cross the placenta and to be distributed in breast milk in animals.
 
Approximately 60% of an auranofin dose is excreted in the urine, and the remainder is excreted in the feces. The elimination half-life of auranofin following cumulative dosing is 26 days (blood) and 80 days (tissues).
* Dosing Information
 
:* Dosage
 
<!--Off-Label Use and Dosage (Adult)-->
 
<!--Guideline-Supported Use (Adult)-->
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* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
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* Dosing Information
 
:* Dosage
 
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<!--Pediatric Indications and Dosage-->
 
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
|fdaLIADPed======Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Off-Label Use and Dosage (Pediatric)-->
 
<!--Guideline-Supported Use (Pediatric)-->
|offLabelPedGuideSupport======Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Non–Guideline-Supported Use (Pediatric)-->
|offLabelPedNoGuideSupport======Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Contraindications-->
|contraindications=* Condition1
 
<!--Warnings-->
|warnings=* Description
 
====Precautions====
 
* Description
 
<!--Adverse Reactions-->
 
<!--Clinical Trials Experience-->
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=====Body as a Whole=====
 
 
 
 
=====Cardiovascular=====
 
 
 
 
=====Digestive=====
 
 
 
 
=====Endocrine=====
 
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
 
=====Metabolic and Nutritional=====
 
 
 
 
=====Musculoskeletal=====
 
 
 
 
=====Neurologic=====
 
 
 
 
=====Respiratory=====
 
 
 
 
=====Skin and Hypersensitivy Reactions=====
 
 
 
 
=====Special Senses=====
 
 
 
 
=====Urogenital=====
 
 
 
 
=====Miscellaneous=====
 
 
 
<!--Postmarketing Experience-->
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
 
=====Body as a Whole=====
 
 
 
=====Cardiovascular=====
 
 
 
=====Digestive=====
 
 
 
=====Endocrine=====
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
=====Metabolic and Nutritional=====
 
 
 
=====Musculoskeletal=====
 
 
 
=====Neurologic=====
 
 
 
=====Respiratory=====
 
 
 
=====Skin and Hypersensitivy Reactions=====
 
 
 
=====Special Senses=====
 
 
 
=====Urogenital=====
 
 
 
=====Miscellaneous=====
 
 
 
<!--Drug Interactions-->
|drugInteractions=* Drug
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<!--Use in Specific Populations-->
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|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
 
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
 
<!--Administration and Monitoring-->
|administration=* Oral
 
* Intravenous
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
 
* Description
 
<!--IV Compatibility-->
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
 
<!--Overdosage-->
|overdose====Acute Overdose===
 
====Signs and Symptoms====
 
* Description
 
====Management====
 
* Description
 
===Chronic Overdose===
 
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
 
<!--Pharmacology-->
 
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: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
 
<!--Pharmacodynamics-->
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<!--Pharmacokinetics-->
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
 
<!--Nonclinical Toxicology-->
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===Pill Images===
<!--How Supplied-->
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|howSupplied=*
{{PillImage|fileName=RIDAURA_NDC_654830093.jpg|drugName=RIDAURA|NDC=654830093|drugAuthor=Prometheus Laboratories Inc.|ingredients=auranofin[auranofin]|pillImprint=RIDAURA|dosageValue=mg|dosageUnit=|pillColor=Brown|pillShape=Capsule|pillSize=14|pillScore=1}}
|packLabel=<!--Patient Counseling Information-->
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.


<!--Precautions with Alcohol-->
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


==Mechanism of Action==
<!--Brand Names-->
Auranofin contains 29% gold. Like other gold compounds, auranofin exhibits antiarthritic, anti-inflammatory, and immunomodulating properties. Gold compounds are known as disease-modifying drugs. Auranofin may modify disease activity; reduced synovitis and ESR may occur. No substantial evidence, however, exists to support induction of rheumatoid arthritis (RA) remission by gold-containing compounds. Gold cannot reverse existing structural damage; best efficacy may occur in patients with active synovitis.
|brandNames=* ®<ref>{{Cite web | title =  | url = }}</ref>
The mechanism of the antiarthritic effects of auranofin is unknown. Auranofin appears to induce heme oxygenase 1 (HO-1) mRNA. Heme oxygenase 1 is an inducible heme-degrading enzyme with anti-inflammatory properties. Induction of HO-1 appears to suppress inflammatory responses in patients with RA. Auranofin incubation of synovial cells from patients with RA led to HO-1 expression induction in a concentration-dependent manner. Further, cells incubated with auranofin had significantly suppressed TNFalpha mRNA expression and COX-2 expression in a dose-dependent manner. Expression levels of TNFalpha mRNA and COX-2 protein were negatively correlated with the level of HO-1 protein. The impact of HO-1 induction inhibition by use of a HO-1 small interfering RNA was examined. Incubation of the cell lines with auranofin and HO-1 small interfering RNA reduced the induction of HO-1 mRNA as compared with incubation of the cells with only auranofin. Further, the TNF alpha mRNA concentration in the presence of HO-1 small interfering RNA was similar to the control value. Thus, auranofin appears to induce HO-1 mRNA, which reduces TNF alpha mRNA expression.
Clinical applications:
Gold compounds, which accumulate slowly in the body and, over time, reduce inflammation, especially related to rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, membranous nephritis, lupus erythematosus and, infrequently, juvenile rheumatoid arthritis (JRA).
Dosage forms &administration:
Auranofin is administered as 2 x 3mg tablets daily, initially in divided doses then as a single daily dose if tolerated. If response is inadequate after 4-6 months this may be increased to 3mg three times a day. If there is no response after a further 3 months the treatment should be discontinued.
Auranofin tablets should be taken with or just after food.
Contraindications:
• Most Significant
Chronic Heart Failure, Diabetes Mellitus, Disease of Liver, Exfoliative Dermatitis, Hepatitis, Hypertension, Necrotizing Enterocolitis, Pregnancy, Pulmonary Fibrosis, Renal Disease
• Significant
Blood Dyscrasias, Colitis, Eczema, Leukopenia, Neutropenic Disorder, Severe Debilitation, Sjogren's Syndrome, Systemic Lupus Erythematosus, Thrombocytopenic Disorder, Urticaria


<!--Look-Alike Drug Names-->
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web  | last =  | first =  | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>


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==DRUG INTERACTIONS==
Auranofin should be avoided by patients with a history of serious reaction to any gold medication, including Solganal and Myochrysine. Auranofin should not be used together with penicillamine, another arthritis medication. It should also be avoided in patients with blood, liver or kidney diseases, recent radiation treatment, or uncontrolled diabetes. Patients should report to their practitioners any new rashes, itching, mouth sores, or unusual taste while taking auranofin. Gold is excreted slowly from the body. Safety and effectiveness in children has not been established.
===PREGNANCY===
Auranofin shouldn't be used during pregnancy. women of child bearing potential shouldn't be treated with auranofin without balancing full consideration of the  benefits of the  treatment against the potential risk of teratogenicity.
===NURSING MOTHERS===
It has been found in the breast milk of nursing mothers.


==SIDE EFFECTS==
 Abdominal Pain with Cramps, Anorexia, Conjunctivitis, Diarrhea, Flatulence, Nausea, Proteinuria, Pruritus of Skin, Skin Rash, Stomatitis, Vomiting
 less frequent
Alopecia, Constipation, Dysgeusia, Eosinophilia, Glossitis, Hematuria, Leukopenia, Purpura, Thrombocytopenic Disorder, Urticaria
 Rare:
Agranulocytosis, Anemia, Angioedema, Aplastic Anemia, Dysphagia, Erythroblastic Anemia, Gastrointestinal Hemorrhage, Gingivitis, Hepatitis, Hypoplastic Anemia, Interstitial Pneumonitis, Jaundice, Pancytopenia, Peripheral Neuropathy, Ulcerative Enterocolitis
Precautions:
 Proteinuria: Transient mild proteinuria is common. If urinalysis reveals protein >1+ or blood >1+ perform MSSU. If negative, perform 24hr urine collection and if >0.5g protein discontinue Auranofin and refer to Specialist.
 Diarrhoea: May be reduced by adding fibre to the diet. Discontinue therapy if severe or persistent.
 Rash: often non-specific erythematous, dry and itchy – may occur early in therapy especially when full doses are given from the start. Antihistamines, steroid cover, or temporary reduction of dose will control urticarial reactions. Discontinue auranofin and refer to Specialist if toxicity suspected.
 Mouth ulcers / Stomatitis: If mild consider mouthwashes. If persistent or severe discontinue auranofin and refer to Specialist.
 Dyspnoea: Pulmonary complications are rare but potentially serious – refer to Specialist.
 Contraception / Pregnancy: Auranofin should not be administered to patients who are pregnant and therapy should be stopped when pregnancy is confirmed or suspected. Significant amounts of gold are excreted in breast milk and therefore lactating mothers should not breast feed their infants.


<!--Label Display Image-->




==See also==
* [[Aurothioglucose]]
* [[Disodium aurothiomalate]]
* [[Sodium aurothiomalate]]


==External links==
* {{MedlinePlusDrugInfo|medmaster|a685038}}
* [http://www.cochrane.org/reviews/en/ab002048.html Cochrane review - "Auranofin versus placebo in rheumatoid arthritis"]
* {{cite journal | author = Jeon K, Byun M, Jue D | title = Gold compound auranofin inhibits IkappaB kinase (IKK) by modifying Cys-179 of IKKbeta subunit. | journal = Exp Mol Med | volume = 35 | issue = 2 | pages = 61-6 | year = 2003 | id = PMID 12754408}}
* {{cite journal | author = Kim I, Jin J, Lee I, Park S | title = Auranofin induces apoptosis and when combined with retinoic acid enhances differentiation of acute promyelocytic leukaemia cells ''in vitro''. | journal = Br J Pharmacol | volume = 142 | issue = 4 | pages = 749-55 | year = 2004 | id = PMID 15159275}}
* {{cite journal | author = Venardos K, Harrison G, Headrick J, Perkins A | title = Auranofin increases apoptosis and ischaemia-reperfusion injury in the rat isolated heart. | journal = Clin Exp Pharmacol Physiol | volume = 31 | issue = 5-6 | pages = 289-94 | year = | id = PMID 15191400}}
* {{cite journal | author = Hafejee A, Winhoven S, Coulson I | title = Jessner's lymphocytic infiltrate responding to oral auranofin. | journal = J Dermatolog Treat | volume = 15 | issue = 5 | pages = 331-2 | year = 2004 | id = PMID 15370403}}
* {{cite journal | author = Rigobello M, Folda A, Baldoin M, Scutari G, Bindoli A | title = Effect of auranofin on the mitochondrial generation of hydrogen peroxide. Role of thioredoxin reductase. | journal = Free Radic Res | volume = 39 | issue = 7 | pages = 687-95 | year = 2005 | id = PMID 16036347}}


[[Category:Gold compounds]]
[[Category:Immunosuppressive agents]]


{{pharma-stub}}
<!--Category-->
{{Anti-inflammatory and antirheumatic products}}


[[de:Auranofin]]
[[Category:Drug]]

Revision as of 18:48, 11 February 2015

Auranofin
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

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Black Box Warning

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Auranofin is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Condition1
  • Dosing Information
  • Dosage
Condition2
  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
  • Dosage
Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Auranofin in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Auranofin in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Auranofin in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Auranofin in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Auranofin in pediatric patients.

Contraindications

  • Condition1

Warnings

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Auranofin in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Auranofin in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Auranofin in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Auranofin during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Auranofin with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Auranofin with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Auranofin with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Auranofin with respect to specific gender populations.

Race

There is no FDA guidance on the use of Auranofin with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Auranofin in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Auranofin in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Auranofin in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Auranofin in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Auranofin in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Auranofin in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Auranofin in the drug label.

Pharmacology

There is limited information regarding Auranofin Pharmacology in the drug label.

Mechanism of Action

Structure

File:Auranofin01.png
This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Auranofin in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Auranofin in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Auranofin in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Auranofin in the drug label.

How Supplied

Storage

There is limited information regarding Auranofin Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

{{#ask: Label Page::Auranofin |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Auranofin in the drug label.

Precautions with Alcohol

  • Alcohol-Auranofin interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. Empty citation (help)
  2. "http://www.ismp.org". External link in |title= (help)

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