Classification:Antiarthritic,oralgoldcompoundAction/Kinetics:Auranofinisagold-containing(29%)compoundforPOadministration.Ithasfewersideeffectsthaninjectablegoldproducts.Althoughthemechanismisnotknown,auranofinwillimprovesymptomsofrheumatoidarthritis;itismosteffectiveintheearlystagesofactivesynovitisandmayactbyinhibitingsulfhydrylsystems.Otherpossiblemechanismsincludeinhibitionofphagocyticactivityofmacrophagesandpolymorphonuclearleukocytes,alterationofbiosynthesisofcollagen,andalterationoftheimmuneresponse.Goldwillnotreversedamagetojointscausedbydisease.Approximately25%ofanoraldoseisabsorbed.Plasmat1/2ofauranofingold:26days.Onset:3-4months(upto6monthsincertainclients).Approximately3monthsarerequiredforsteady-statebloodlevelstobeachieved.Thedrugismetabolizedandexcretedinboththeurineandfeces.Adultsandchildrenwithrheumatoidarthritisthathavenotrespondedtootherdrugs.Upto6monthsmayberequiredforbeneficialeffectstooccur.Auranofinshouldbepartofatotaltreatmentregimenforrheumatoidarthritis,includingnondrugtreatments.CapsulesRheumatoidarthritis.Adults,initial:Either6mg/dayor3mgb.i.d.Ifresponseisunsatisfactoryafter6months,increaseto3mgt.i.d.Ifresponseisstillinadequateafter3additionalmonths,discontinuethedrug.Dosagesgreaterthan9mg/dayarenotrecommended.Children,initial:0.1mg/kg/day;maintenance:0.15mg/kg/day,nottoexceed0.2mg/kg/day.Transferfrominjectablegold.Discontinueinjectablegoldandbeginauranofinatadoseof6mg/day.PregnancyCategory:CContraindications:Historyofgold-induceddisordersincludingnecrotizingenterocolitis,pulmonaryfibrosis,exfoliativedermatitis,bonemarrowaplasia,orotherhematologicseveredisorders.Useduringlactation.SpecialConcerns:Usewithextremecautioninrenalorhepaticdisease,skinrashes,markedhypertension,compromisedcerebralorCVcirculation,orhistoryofbonemarrowdepression(e.g.,agranulocytopenia,anemia).Golddermatitismaybeaggravatedbyexposuretosunlight.Althoughusedinchildren,arecommendeddosagehasnotbeenestablished.Tolerancetogoldisoftendecreasedingeriatricclients.GI:N&V,diarrhea(common),abdominalpain,metallictaste,stomatitis,glossitis,gingivitis,anorexia,constipation,flatulence,dyspepsia,dysgeusia,melena.Rarely,dysphagia,GIbleeding,ulcerativeenterocolitis.Dermatologic:Skinrashes,pruritus,alopecia,urticaria,angioedema,actinicrash.Hematologic:Leukopenia,anemia,thrombocytopenia(withorwithoutpurpura),neutropenia,agranulocytosis,eosinophilia,pancytopenia,hypoplasticanemia,aplasticanemiapureredcellaplasia.Renal:Proteinuria,hematuria.Hepatic:Jaundice(withorwithoutcholestasis,hepatitiswithjaundice,toxichepatitisintrahepaticcholestasis.Other:Conjunctivitis,cholestaticjaundice,fever,interstitialpneumoniaandfibrosis,peripheralneuropathy.Symptoms:Rapidappearanceofhematuria,proteinuria,thrombocytopenia,granulocytopenia.Also,N&V,diarrhea,fever,urticaria,papulovesicularlesions,urticaria,exfoliativedermatitis,pruritus.Treatment:Discontinuepromptlyandgivedimercaprol.Supportivetherapyshouldbeprovidedforrenalandhematologicsymptoms.Treatmoderatelysevereskinandmucousmembranesymptomswithtopicalcorticosteroids,oralantihistamines,andanestheticlotions.Treatseverestomatitisordermatitiswithprednisone,10-40mgdaily.Treatseriousrenal,hematologic,pulmonary,andenterocoliticcomplicationswithprednisone,40-100mgdailyindivideddoses.Thedurationoftreatmentvaries,dependingontheseverityofsymptomsandtheresponsetosteroids.Inacuteoverdosage,induceemesisorperformgastriclavageimmediately.坏死性小肠结肠炎，肺纤维化，剥脱性皮炎，骨髓再生障碍，进行性肾病，严重肝病和其它血液系统疾病。