GOLD SODIUM THIOMALATE
(thye-oh-mah'late)
Myochrysine
Classifications: gold compound
Prototype: Aurothioglucose
Pregnancy Category: C

Availability

50 mg/mL injection

Actions

Water-soluble gold compound similar to aurothioglucose in actions and uses. Has immunomodulatory and antiinflammatory effects. Action mechanism unclear. Drug appears to act by suppression of phagocytosis, altered immune responses, and possibly by inhibition of prostaglandin synthesis.

Therapeutic Effects

Has immunomodulatory and antiinflammatory effects.

Uses

Selected patients (adults and juveniles) with acute rheumatoid arthritis.

Unlabeled Uses

Psoriatic arthritis, Felty's syndrome.

Contraindications

History of severe toxicity from previous exposure to gold or other heavy metals; severe debilitation; SLE, Sjögren's syndrome in rheumatoid arthritis; renal disease; hepatic dysfunction, history of infectious hepatitis or hematologic disorders; uncontrolled diabetes or CHF. Safe use during pregnancy (category C) and lactation is not established.

Cautious Use

History of drug allergies or hypersensitivity, hypertension.

Route & Dosage

Rheumatoid Arthritis
Adult: IM 10 mg wk 1, 25 mg wk 2, then 25–50 mg/wk to a cumulative dose of 1 g (if improvement occurs, continue at 25–50 mg q2 wk for 2–20 wk, then q3–4 wk indefinitely or until adverse effects occur)
Child: IM 10 mg test dose, then 1 mg/kg/wk or 2.5–5 mg for wk 1 and 2, followed by 1 mg/kg q1–4 wk (max: single dose 50 mg)

Administration

Intramuscular

Adverse Effects (1%)

CNS: Dizziness, syncope, sweating, flushing. CV: Bradycardia. GI: Hepatitis, metallic taste, stomatitis, nausea, vomiting. Hematologic: Agranulocytosis, aplastic anemia, eosinophilia (all rare). Urogenital: Nephrotic syndrome, glomerulitis with hematuria, proteinuria. Skin: Transient pruritus, erythema, dermatitis, fixed drug eruption, alopecia, shedding of nails, gray to blue pigmentation of skin (chrysiasis). Special Senses: Gold deposits in ocular tissues, photosensitivity. Body as a Whole: Peripheral neuritis, angioneurotic edema, interstitial pneumonitis, anaphylaxis (rare). Respiratory: Pulmonary fibrosis.

Interactions

Drug: antimalarials, immunosuppressants, penicillamine, phenylbutazone increase risk of blood dyscrasias.

Pharmacokinetics

Absorption: Slowly and irregularly absorbed from IM site. Peak: 3–6 h. Distribution: Widely distributed, especially to synovial fluid, kidney, liver, and spleen; does not cross blood–brain barrier; crosses placenta. Metabolism: Not studied. Elimination: 60–90% of dose ultimately excreted in urine; also eliminated in feces; traces may be found in urine for 6 mo. Half-Life: 3–168 d.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug