Aurothioglucose
Aurothioglucose is an injectable **gold salt** historically used in veterinary medicine for its immunomodulatory and anti-inflammatory properties. * This therapy, known as **chrysotherapy**, was primarily utilized for treating severe immune-mediated skin diseases such as **pemphigus foliaceus** and immune-mediated polyarthritis. * **Clinical Pearl:** Due to the advent of safer, faster-acting, and more effective immunosuppressive agents (e.g., cyclosporine, mycophenolate, glucocorticoids), the use of aurothioglucose has largely fallen out of favor in modern veterinary practice. * It requires a prolonged onset of action (often weeks to months) and carries a significant risk of severe, potentially life-threatening adverse effects, including profound bone marrow suppression and nephrotoxicity.
Mecanismo: The exact mechanism of **chrysotherapy** remains incompletely understood, but it is known to exert profound immunomodulatory effects. * **Macrophage Inhibition:** Gold compounds are taken up by **macrophages** → inhibition of phagocytosis → decreased release of lysosomal enzymes and inflammatory mediators. * **T-Cell Modulation:** Alters cellular immunity by reducing the proliferation and activation of **T-lymphocytes**. * **Autoantibody Reduction:** Decreases the production of **rheumatoid factor** and other autoantibodies. * Inhibits **prostaglandin synthesis** and complement activation, contributing to its anti-inflammatory effects.
Vías de administración
Contraindicaciones
- Pre-existing renal disease
- Hepatic dysfunction
- Severe hematologic disorders or pre-existing cytopenias
- Systemic lupus erythematosus (SLE)
- Pregnancy and lactation
- History of severe toxicity to heavy metals
Efectos adversos
- Bone marrow suppression (thrombocytopenia, anemia, leukopenia)
- Nephrotoxicity (proteinuria, glomerulonephritis)
- Hepatotoxicity
- Stomatitis and oral ulcers
- Dermatologic reactions (Toxic epidermal necrolysis, Erythema multiforme)
- Anaphylaxis (rare)
Interacciones farmacológicas
- Penicillamine · Increased risk of severe hematologic and renal toxicity.
- Immunosuppressants (e.g., cyclophosphamide, azathioprine) · Synergistic bone marrow suppression; use together with extreme caution.
- Phenylbutazone · Increased risk of blood dyscrasias.
Monitorización
- Complete Blood Count (CBC) with platelets (prior to every dose)
- Urinalysis (specifically monitoring for proteinuria prior to every dose)
- Liver enzyme panels
- Renal function panels (BUN, Creatinine)
- Clinical signs of bleeding, bruising, or oral ulcers
Sobredosis
Overdosage can lead to severe heavy metal toxicity. * **Symptoms:** Profound bone marrow suppression (bleeding, severe infections), acute renal failure, and severe gastrointestinal signs. * **Treatment:** Involves immediate discontinuation of the drug, aggressive supportive care, and potential use of heavy metal chelating agents such as **dimercaprol (BAL)** to enhance excretion.
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