Ridaura, an oral form of gold known generically as auranofin, is a disease-modifying antirheumatic drug (DMARD) used in the treatment of active rheumatoid arthritis. Its use is reserved for adult patients who have not responded adequately to or cannot tolerate nonsteroidal anti-inflammatory drugs (NSAIDs). The therapeutic effect of Ridaura can be slow to appear, taking several months, and it cannot reverse joint damage that has already occurred. Due to the potential for severe adverse reactions, understanding the contraindications is paramount for ensuring patient safety.
Contraindications Related to Previous Gold Toxicity
A history of severe reactions to any gold therapy is a strict contraindication for Ridaura. This includes gold-induced disorders such as anaphylaxis, necrotizing enterocolitis, pulmonary fibrosis, exfoliative dermatitis, and bone marrow aplasia or other severe hematologic disorders.
Organ Dysfunction and Systemic Diseases
Ridaura is contraindicated in patients with certain severe pre-existing conditions. These include progressive renal disease, severe hepatic disorders, active inflammatory bowel disease, Systemic Lupus Erythematosus (SLE), and severe chronic skin diseases. Gold can be nephrotoxic and regular urinalysis is needed to monitor for proteinuria or hematuria.
Drug-Drug Interactions
Combining Ridaura with certain other medications can increase the risk of serious adverse effects and is generally discouraged or contraindicated.
Comparison of Ridaura and Interacting Drugs
| Interacting Drug Category | Potential Risk with Ridaura | Monitoring Requirements |
|---|---|---|
| Other Gold Salts (e.g., gold injections) | Increased risk of severe gold toxicity. | Concurrent use is contraindicated. |
| Penicillamine | Additive hematologic and renal toxicity. | Concurrent use is generally contraindicated. |
| Immunosuppressants (e.g., methotrexate, azathioprine, cyclophosphamide) | Increased risk of severe hematologic toxicity. | Concurrent use is not recommended; careful monitoring required if unavoidable. |
| High-Dose Corticosteroids | Risk of additive toxicity. | Concurrent use is generally not recommended, especially at high doses. |
| Phenytoin | Potential increase in phenytoin blood levels and risk of toxicity. | Careful monitoring of phenytoin levels and signs of toxicity. |
| Antimalarials (e.g., hydroxychloroquine) | Safety of concomitant use is not established. | Use with caution; monitor for signs of increased toxicity. |
Pregnancy, Lactation, and Pediatric Use
Ridaura is not recommended during pregnancy due to potential harm to the fetus. Women who could become pregnant should use effective contraception during treatment and for six months after. It is also not recommended for breastfeeding women because auranofin is excreted into breast milk. The safety and effectiveness in children under 18 have not been established.
Conclusion
Ridaura is a potent medication with a narrow therapeutic index, increasing the risk of toxicity. Its contraindications are related to severe adverse effects impacting blood, kidneys, liver, and skin. Healthcare providers must evaluate a patient's medical history and current medications before prescribing Ridaura. Patients need to be informed about gold toxicity signs and the necessity of regular monitoring. The decision to use Ridaura must balance benefits against significant risks and contraindications. For more information, refer to the official prescribing information on DailyMed. DailyMed
