Usual Adult Dose for Rheumatoid Arthritis

3 mg orally 2 times a day OR 6 mg orally once a day; if response is inadequate after 6 months, increase to 3 mg orally 3 times a day; discontinue therapy if response is inadequate after 3 months at 9 mg/day

Comments:

• Therapy should not be initiated at doses exceeding 6 mg daily because it is associated with an increased incidence of diarrhea.
• This drug should be added to a comprehensive program, including nondrug therapies.
• This drug does not produce an immediate response. Therapeutic effects may be seen after 3 to 4 months, although improvement has not been seen in some patients before 6 months.
• Gold cannot reverse structural damage to joints caused by previous disease. The greatest potential benefit occurs in patients with active synovitis, particularly in its early stage.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Transferring from Injectable Gold:

• Discontinue the injectable gold and start oral therapy at 6 mg daily in 1 to 2 divided doses.
• Inform patients of the adverse reaction profile of this drug, particularly GI reactions.
• At 6 months, control of disease activity of patients transferred to this drug and those maintained on injectable gold was not different. Data beyond 6 months are not available.

Precautions

US BOXED WARNINGS:

• This drug contains gold and can cause gold toxicity. Symptoms include: fall in hemoglobin, leukopenia below 4000 WBC/cu mm, granulocytes below 1,500/cu mm, decrease in platelets below 150,000/cu mm, proteinuria, hematuria, pruritus, rash, stomatitis or persistent diarrhea. Laboratory work should be reviewed before writing each prescription. This drug is only indicated for use in selected patients with active rheumatoid arthritis. Physicians should be experienced with chrysotherapy and the toxicity of this drug.
• Advise patients of the possibility of adverse reactions before initiating therapy.
• Advise patients to immediately report any symptoms of toxicity.

Dialysis

Data not available

Other Comments

Monitoring:

• CBC with differential, platelet count, urinalysis, and renal and liver function tests should be performed prior to initiation of therapy to establish a baseline and to identify any preexisting conditions.