They should be questioned for the presence of pruritus, rash, stomatitis or metallic taste. Hematologic reactions have been observed rarely but fatalities have ensued. Other severe toxic manifestations include cholestatic jaundice, enterocolitis and interstitial lung disease. If toxicity develops, sodium aurothiomalate should be discontinued immediately and symptomatic treatment be given as required. If the reaction to gold therapy is not of a serious type, injections may be cautiously resumed 2 or 3 weeks after the toxic reaction has subsided.
Severe reactions are a contraindication to further gold therapy.
It has been proposed that serious reactions may be the result of failure to discontinue therapy when earlier less serious symptoms occur. A transient flare of articular inflammation appearing within 24 hours of injection and lasting 2 or 3 days has also been reported. Gold therapy should be discontinued promptly and supportive treatments should be given as required for specific complications. Patients with severe dermatitis may benefit from oral antihistamines, topical corticosteroids or emollients. Because of the possibility of anaphylactic reaction, it is recommended that patients be kept under medical observation for a period of 30 minutes after the administration of the drug.