Gold preparations

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 30.09.2022

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Definition
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Antirheumatic drugs, basic therapeutics. For example, auranofin, sodium aurothiomalate.

Indication
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Psoriatic arthritis, rheumatoid arthritis.

Notice! Before starting therapy, pregnancy must be ruled out and effective contraception must be carried out during therapy!

Limited indication
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Insulin-dependent diabetes mellitus, sun exposure (including artificial UV radiation).

Undesirable effects
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See Table 1.

Interactions
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See Table 2.

Contraindication
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Pregnancy, lactation, agranulocytosis, atopic diathesis, autoimmune diseases (dermatomyositis, systemic lupus erythematosus, scleroderma), haematopoietic disorders, bleeding tendency, ulcerative colitis, severe liver and kidney dysfunction, thrombocytopenia, active pulmonary tuberculosis, hypersensitivity to heavy metals.

Tables
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Side effects of gold preparations

Airways

allergic alveolitis, bronchiolitis, interstitial pulmonary fibrosis (under therapy 1 time/year X-ray control of the thorax!)

blood, lymph

Agranulocytosis, hypo- to aplastic or hemolytic anemia,

Eosinophilia (therapy discontinuation in > 12%)

Leukopenia, neutropenia, thrombocytopenia (discontinuation of therapy if < 100,000 platelets/μl), pancytopenia,

thrombocytopenic purpura

GIT

Loss of appetite, vomiting, diarrhea

Cholestasis, jaundice, hepatitis

Gastrointestinal bleeding

Transaminase elevations, rarely hepatic necrosis

Urinary tract

Albuminuria, hematuria, proteinuria (discontinuation of therapy at > 300 mg protein/l urine), cylindruria

Glomerulonephritis, immune complex nephritis

gold nephropathy, tubular necrosis

acute renal failure

Skin

allergic exanthema, pityriasis rosea-like reactions, pruritus, alopecia, Quincke's edema, anaphylactic shock, Lyell's syndrome

gingivitis, stomatitis

Photosensitization

gray-blue pigmentation, especially in light-exposed areas

intradermal gold deposits

drug-induced lupus erythematosus

onycholysis, hyperhidrosis

Cardiovascular

bradycardia, tachyarrhythmia

Nervous system

EEG changes, headache, seizures, hallucinations, confusional states

Encephalopathy, encephalitis, neuropathy, neuritis

Guillain-Barré syndrome

Sensory organs

metallic taste

Chrysiasis (gold deposits in eye tissue)

corneal ulcers

iritis, conjunctivitis, neuritis optic nerves

supporting apparatus

Arthralgias

Pain at the injection site in case of i.m. application Application

Significant interactions of gold preparations

Butazone

Reciprocal toxicity ↑, avoid combination.

Chloroquine

Retinopathy risk ↑.

Clozapine

Agranulocytosis, avoid combination

Iron

Gold effect with oral administration ↓

Metamizole

reciprocal toxicity ↑, avoid combination

NSAIDS

Blood formation disorders, mutual toxicity ↑.

Penicillamine

Blood formation disorders, kidney damage, gold effect ↓, avoid combination

Cytostatics

mutual toxicity ↑, avoid combination

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Last updated on: 30.09.2022