Aurothiomalate reactions

The complexes sodium aurothiomalate and sodium aurothioglucose provide effective therapy for rheumatoid arthritis but can produce unpleasant and toxic reactions because of the relatively large doses used (up to 250jumol (50 mg) per week). The resultant high concentrations of Au in plasma of patients receiving chrysotherapy may be measured easily by solvent extraction and FAAS. The main advantages of ETA—AAS are the direct analysis and the sensitivity to measure the various Au containing species in body fluids. 

Nitritoid reactions have been reported rarely in patients receiving therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy, Symptoms may include facial flushing, nausea, vomiting and hypotension. Be aware,... 

ACE INHIBITORS GOLD (SODIUM AUROTHIOMALATE) Cases of 1 BP Additive vasodilating effects Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (lightheadedness, dizziness on standing, etc.). If reaction occurs, consider changing to alternative gold formulation or stopping ACE inhibitor... 

Apart from the nitritoid cardiovascular reaction, which is unique to sodium aurothiomalate, and possible differences between slowly and rapidly absorbed gold salts in the relative frequency of adverse effects, the general pattern of adverse reactions is similar for all parenteral gold salts. 

A 30-year-old Japanese man with polyarthritis, in whom sodium aurothiomalate for 3 years had been ineffective, was given penicillamine 200 mg/day (188). After 10 days he became febrile and 2 days later jaundiced. A lymphocyte stimulation test against penicillamine was positive, suggesting type IV hypersensitivity. Later on he had a good response to tiopronin, without further adverse reactions. 

Wooley PH, Griffin , PanayiGS, Batchelor R, Welsh Kl, Gibson HLA-DR antigens and toxic reaction to sodium aurothiomalate and D-penIclllamlne in patients with rheumatoid arthritis. N. Engl. . Med. 1980 303 300-302. 

Benson WG, Moore N,Tugwell P, D, Souza M, Singal DP. HLA antigens and toxic reactions to sodium aurothiomalate in patients with rheumatoid arthritis. J Rheumatol 1984 11 358-361. 

Bretza J, Wells I, Novey HS. Association of IgE antibodies to sodium aurothiomalate and adverse reactions to chrysotherapy for rheumatoid arthritis. Am J Med 1983 74 945-950. 

Gold salts (sodium aurothiomalate) used in the treatment of rheumatoid arthritis have produced pulmonary fibrosis with cough, dyspnea, and pleuritic pain 5 to 16 weeks following institution of therapy. Pulmonary function tests show a restrictive defect, and patients generally have an eosinophilia. The reactions improve on discontinuation of the gold therapy and recur promptly on reexposure. The pulmonary deficit may not resolve completely. 

Thiol Uptake and Exchange Reactions of Aurothiomalate ( Myocrisin")... 

---