Ridaura

auranofin

(au-rane-oh-fin) ,

Ridaura

(trade name)

Classification

Therapeutic: antirheumatics
Pregnancy Category: C

Indications

Treatment of progressive rheumatoid arthritis resistant to conventional therapy.

Action

Inhibits inflammatory process.
Modifies immune response (immunomodulating properties).

Therapeutic effects

Relief of pain and inflammation.
Slowing of the disease process in rheumatoid arthritis.

Pharmacokinetics

Absorption: 20–25% absorbed from the GI tract.
Distribution: Widely distributed; appears to concentrate in arthritic joints more than in uninvolved joints. Enters breast milk.
Metabolism and Excretion: 60% of absorbed dose slowly excreted by the kidneys; 40% of absorbed dose excreted in the feces.
Half-life: 26 days in blood, 40–128 days in tissue.

Time/action profile (anti-inflammatory activity)

ROUTEONSETPEAKDURATION
PO3–6 mounknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Previous gold toxicity (e.g. anaphylaxis, necrotizing enterocolitis, pulmonary fibrosis, exfoliative dermatitis, bone marrow aplasia, hematologic disorders); Obstetric: Potential for congenital anomalies; Lactation: Appears in breast milk. Use formula or discontinue auranofin.
Use Cautiously in: History of blood dyscrasias; Rashes; Severe hepatic or renal dysfunction; Inflammatory bowel disease; Patients taking other immunosuppressant drugs; Pediatric: Efficacy and safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • peripheral neuropathy

Ear, Eye, Nose, Throat

  • conjunctivitis
  • corneal gold deposition

Genitourinary

  • proteinuria,
  • hematuria

Respiratory

  • bronchitis
  • pulmonary fibrosis
  • pneumonitis

Cardiovascular

  • bradycardia

Gastrointestinal

  • gi bleeding (life-threatening)
  • abdominal pain (most frequent)
  • cramping (most frequent)
  • diarrhea (most frequent)
  • gingivitis
  • glossitis
  • metallic taste
  • stomatitis (most frequent)
  • anorexia
  • difficulty swallowing
  • ↑ liver enzymes
  • dyspepsia
  • flatulence
  • nausea
  • vomiting

Dermatologic

  • dermatitis (most frequent)
  • rash (most frequent)
  • alopecia
  • urticaria
  • photosensitivity reactions
  • pruritus (most frequent)

Hematologic

  • agranulocytosis (life-threatening)
  • aplastic anemia (life-threatening)
  • thrombocytopenia
  • anemia
  • eosinophilia
  • leukopenia

Miscellaneous

  • allergic reactions, including anaphylaxis (life-threatening)
  • angioedema (life-threatening)

Interactions

Drug-Drug interaction

Bone marrow toxicity may be additive with other myelosuppressive agents (antineoplastics, radiation therapy, azathioprine ) or high doses of corticosteroids.Concurrent use with penicillamine ↑ the risk of adverse hematologic or renal reactions.May ↑ blood levels of phenytoin.

Route/Dosage

Oral (Adults) 6 mg/day in 1–2 doses; may ↑ to 9 mg/day in 3 divided doses if no improvement after 6 mo.

Availability

Capsules: 3 mg

Nursing implications

Nursing assessment

  • Assess range of motion and degree of swelling and pain in affected joints before and periodically throughout therapy.
  • Lab Test Considerations: Monitor renal, hepatic, and hematologic function and urinalysis before and monthly during therapy. May cause thrombocytopenia, leukopenia, and anemia. May also cause ↑ liver enzymes, proteinuria, and hematuria.
  • Rapid decrease in hemoglobin, WBC <4000/mm3, granulocytes <1500/mm3, or platelets <150,000/mm3, albuminuria, hematuria, rash, dermatitis, pruritus, skin eruption, stomatitis, persistent diarrhea, jaundice, or petechiae may indicate gold toxicity. Withhold therapy until toxicity has been ruled out. If signs of overdose occur, corticosteroids are usually used to reverse effects. A chelating agent, dimercaprol (BAL), may be given to enhance gold excretion when corticosteroids are ineffective.

Potential Nursing Diagnoses

Impaired physical mobility (Indications)
Diarrhea (Side Effects)

Implementation

  • Oral: Administer with meals to minimize gastric irritation.

Patient/Family Teaching

  • Instruct patient to take medication exactly as directed; do not skip or double doses. Take missed dose as soon as possible except if next dose is almost due.
  • Concurrent therapy with salicylates or other NSAIDs or corticosteroids is usually necessary, especially during the first few months of gold therapy. Patients should continue physical therapy and ensure adequate rest. Explain that joint damage will not be reversed; the goal is to slow or stop the disease process.
  • Emphasize the importance of good oral hygiene to reduce stomatitis.
  • Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
  • Instruct patient to report symptoms of leukopenia (fever, sore throat, signs of infection); thrombocytopenia (bleeding gums; bruising; petechiae; blood in stools, urine, or emesis); or gold toxicity immediately. Diarrhea may be resolved by decreasing the dose.
  • Emphasize the importance of regular visits to health care professional to monitor progress and evaluate blood and urine tests for side effects.
  • Discuss the need for contraception while receiving this medication. Advise female patients to notify health care professional promptly if pregnancy is suspected.

Evaluation/Desired Outcomes

  • Decrease in swelling, pain, and stiffness of joints.
    • Increase in mobility. Continuous therapy for 3–6 mo may be required before therapeutic effects are seen.

Ridaura

(rĭd-ô′rə)
A trademark for the drug auranofin.

Ridaura

a trademark for an oral disease-modifying antirheumatoid drug (auranofin).

Ridaura

A brand name for AURANOFIN.
References in periodicals archive ?
Jat ML, Dagar JC, Sapkota TB, Singh Y, Govaerts B, Ridaura SL, Saharawat YS, Sharma RK, Tetarwal JP, Jat RK, Hobbs H, Stirling C (2016) Climate change and agriculture: adaptation strategies and mitigation opportunities for food security in South Asia and Latin America.
Intestinal dysbiosis may contribute to a variety of diseases (Konkel 2013; Ridaura et al.
cecilia Lopez Ridaura afirma que dicho "anticlericalismo es predominantemente una actitud social, colectiva y, por tanto, es una manifestacion que se da en la plaza publica bajtiniana" (28).
Many researches have hinted towards a possible relationship between these gut microbiota and obesity (Raoult, 2016; Ridaura et al.
Turnbaugh PJ, Ridaura VK, Faith JJ, Rey FE, Knight R, Gordon JI.
Duran-McKinster C Rodolfo Rodriguez- Jurado R Cecilia Ridaura C et al.
Edited by Flisser A Willms K Laclette JP Larralde C Ridaura C Beltran F.
And normal-weight mice given microbes from obese mice pack on extra fat, says coauthor Vanessa Ridaura, also of Washington University.
Vanessa Ridaura, a graduate student at Washington University's School of Medicine, and colleagues took samples of the microbes that were living in the guts of human fraternal and identical twins.
To start finding out, Washington University graduate student Vanessa Ridaura took gut bacteria from eight people -- four pairs of twins that each included one obese sibling and one lean sibling.
Table 4 Incidence of Adverse Reactions from Oral and Parenteral Aurothiolates Administered to Patients with Rheumatoid Arthritis at an Average Daily Dosage of 3 mg of Gold (Based on 18 Comparative Clinical Trials) * Side Effect Ridaura Injectable Gold (445 patients) (445 patients) Proteinuria 0.