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Gold (Myochrisine,
Solganal)
Available:
50 mg/mL solution
Dose:
10 mg intramuscular injection for the first
dose, followed by 25 mg weekly injections for the second and
third doses; the dose is increased to 50 mg weekly if
tolerated until a total dose of 1 gram is reached or until
improvement is seen; 50 mg can then be given every 2 to 4
weeks
Cost:
Variable, given in an office setting and charged to insurer
Indications:
Treatment of rheumatoid arthritis
Side
effects: Mouth sores, altered taste, rash, lowered blood
counts (esp. platelets), protein in the urine, kidney damage,
elevation of liver enzymes, and rare lung damage
Monitoring:
Blood counts and urine test monthly; consider liver and
kidney function tests every 1 to 3 months
Important
points to know: Injections must be given in a supervised
office setting to monitor for drug reactions. The effects of
therapy may not be seen for 4 to 6 months. Gold is also
available in oral form (auranofin), and while this preparation
is less toxic, it also seems to be less effective and poorly
tolerated due to nausea and diarrhea.
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