SODIUM AUROTHIOMALATE IS GIVEN BY DEEP INTRAMUSCULAR INJECTION; THE AREA SHOULD BE GENTLY MASSAGED AND, DUE TO THE POSSIBILITY OF VASOMOTOR REACTIONS, THE PATIENT SHOULD REMAIN RECUMBENT FOR 10 MINUTES AND KEPT UNDER CLOSE OBSERVATION FOR 30 MINUTES AFTER EACH INJECTION. IN THE UK, 10 MG IS GIVEN IN THE FIRST WEEK TO TEST THE PATIENT'S TOLERANCE. IF SATISFACTORY, THIS MAY BE FOLLOWED BY DOSES OF 50 MG AT WEEKLY INTERVALS UNTIL SIGNS OF REMISSION OCCUR; THE DOSAGE INTERVAL IS THEN INCREASED TO 2 WEEKS UNTIL FULL REMISSION OCCURS AND THEN INCREASED GRADUALLY TO EVERY 4 TO 6 WEEKS. TREATMENT MAY BE CONTINUED FOR UP TO 5 YEARS AFTER REMISSION.
IMPROVEMENT MAY NOT BE SEEN UNTIL A TOTAL DOSE OF 300 TO 500 MG HAS BEEN GIVEN. IF NO MAJOR IMPROVEMENT HAS OCCURRED AFTER A TOTAL OF 1 G HAS BEEN GIVEN (EXCLUDING THE TEST DOSE) THERAPY SHOULD BE STOPPED; ALTERNATIVELY IN THE ABSENCE OF TOXICITY, 100 MG MAY BE GIVEN WEEKLY FOR A FURTHER 6 WEEKS; SHOULD THERE BE NO RESPONSE AT THIS DOSE OTHER FORMS OF THERAPY SHOULD BE TRIED. IN PATIENTS WHO RELAPSE WHILE RECEIVING MAINTENANCE THERAPY, THE INTERVAL BETWEEN DOSES SHOULD BE REDUCED TO ONE WEEK AND SHOULD NOT BE INCREASED AGAIN UNTIL CONTROL HAS BEEN OBTAINED; HOWEVER, IF NO RESPONSE IS OBTAINED WITHIN 2 MONTHS, ALTERNATIVE TREATMENT SHOULD BE USED. IT IS IMPORTANT TO AVOID COMPLETE RELAPSE SINCE A SECOND COURSE OF GOLD THERAPY IS NOT USUALLY EFFECTIVE.
FOR CHILDREN WITH PROGRESSIVE JUVENILE IDIOPATHIC ARTHRITIS THE SUGGESTED INITIAL WEEKLY DOSE IS 1 MG/KG TO A MAXIMUM OF 50 MG WEEKLY (ONE-TENTH TO ONE-FIFTH OF THE CALCULATED INITIAL WEEKLY DOSE MAY BE GIVEN FOR 2 TO 3 WEEKS TO TEST THE PATIENT'S TOLERANCE). WITH FULL REMISSION, THE DOSAGE INTERVAL MAY BE INCREASED GRADUALLY TO EVERY 4 WEEKS. IF NO IMPROVEMENT HAS OCCURRED AFTER 20 WEEKS, THE DOSE COULD BE RAISED SLIGHTLY OR ANOTHER ANTIRHEUMATIC DRUG TRIED.