Gold compounds toxicity

Adverse side effects of gold treatments include stomatitis, rash, and proteinuria. Complete blood counts and urinalysis should be performed before each or every other injection of gold compounds. Pmritic skin rash and stomatitis are more common adverse effects that may resolve, if therapy is withheld for a few weeks and then restarted cautiously at a lower dose. Oral gold causes less mucocutaneous, bone marrow, and renal toxicity than injectable gold, but more diarrhea and other gastrointestinal reactions appear. 

Toxic Effects on the Blood-Forming Tissues Reduced formation of erythrocytes and other elements of blood is an indication of damage to the bone marrow. Chemical compounds toxic to the bone marrow may cause pancytopenia, in which the levels of all elements of blood are reduced. Ionizing radiation, benzene, lindane, chlordane, arsenic, chloramphenicol, trinitrotoluene, gold salts, and phenylbutazone all induce pancytopenia. If the damage to the bone marrow is so severe that the production of blood elements is totally inhibited, the disease state is termed aplastic anemia. In the occupational environment, high concentrations of benzene can cause aplastic anemia. 

MTX is potentially toxic. Therefore, the nurse observes closely for development of adverse reactions, such as thrombocytopenia (see Nursing Alert in Gold Compounds section) and leukopenia (see discussion of adverse reactions associated with hydroxychloroquine). Hematology, liver, and renal function studies are monitored every 1 to 3 months with MTX therapy. The primary care provider is notified of abnormal hematology, liver function, or kidney function finding. The nurse immediately brings all adverse reactions or suspected adverse reactions to the attention of the primary health care provider. 

Toxic reactions are possible when taking gold compounds. Report adverse reactions to the primary health care provider as soon as possible ... 

Sulfasalazine (Azulfidine) is approved for the treatment of rheumatoid arthritis and ulcerative colitis. It is also used to treat ankylosing spondylitis and Crohn s disease. Comparisons of sulfasalazine with other DMARDs suggest that it is more effective than hydroxychloroquine, azathioprine, and oral gold compounds. It is at least as effective as intramuscular gold and penicillamine. It has a greater degree of toxicity than hydroxychloroquine but less than gold compounds and penicillamine. After 5 years, approximately 75% of patients have discontinued sulfasalazine therapy, primarily because of a lack of efficacy as opposed to intolerable side effects. 

Adverse Side Effects. Adverse effects are relatively common with gold therapy, with approximately one third of patients experiencing some form of toxic effect.84 The primary side effects caused by gold compounds are gastrointestinal distress (diarrhea, indigestion), irritation of the oral mucosa, and rashes and... 

Gold compounds were first proved to be effective in a large double-blind trial in 1960. Because of their toxicity, they are used infrequently today. Their intramuscular formulations (aurothiomalate and aurothioglucose) contain 50% elemental gold. The oral formulation (auranofin) contains 29% elemental gold. 

These compounds have high bioavailability after intramuscular administration and tend to concentrate in synovial membranes, liver, kidney, spleen, lymph nodes, and bone marrow. One month after an intramuscular injection, 75-80% of the drug is eliminated from the serum, but intramuscular gold s total body half-life is approximately 1 year. Auranofin is only about 25% bioavailable. Gold compounds are excreted approximately 66% in the urine and 33% via the feces. There has generally been no correlation found between serum gold concentration and either efficacy or toxicity. 

Simultaneous administration of gold compounds with other nephrotoxic, hep-atotoxic, or myelosuppressive and penicillamine drugs must be avoided because of associated toxicities. Metal toxicity can be treated with dimercaprol, and drugs must be withdrawn. 

DOT CLASSIFICATION Forbidden SAFETY PROFILE Explodes at 70°C. When heated to decomposition it emits toxic fumes of Br . See also GOLD COMPOUNDS and BROMIDES. 

SAFETY PROFILE Experimental reproductive effects. Human mutation data reported. Reaction with ammonia or ammonium salts yields fulminating gold, a heat-, friction-, and impact-sensitive explosive similar to mercury and silver fulminates. See also GOLD COMPOUNDS and CHLORIDES. When heated to decomposition it emits toxic fumes of CT. 

Thiomalate (salt of ester of the malic acid) also has been used very successfully to treat severe cases of rheumatoid arthritis. A complete cure or a significant improvement has been noted in approximately 50% of patients using this treatment modality, with 40% of patients exhibiting side effects. Thiomalate is also toxic and possesses cumulative action. Minimal concentrations of the gold compounds reach many cells and remain in the body for years. ... 

Piroxicam may displace highly protein-bound drugs from binding sites. Toxicity may occur with coumarin derivatives, phenytoin, verapamil, or nifedipine. Increased nephrotoxicity may occur with gold compounds, other... 

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