Get rid of gout now... medicines used for treatment!



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit


Colchicine:

Colchicine is an anti-gout drug that works by inhibiting white blood cell function.

It is used to treat acute attacks of gout.

Colchicine is also used as a prophylactic drug. During the first six months of uric acid lowering therapy, patients will often have a paradoxical tendency to have more attacks. Colchicine is used to help prevent these attacks from occurring. Generally after 6 months, patients can discontinue their colchicine.

Colchicine is not specific for gout and may also block attacks of pseudogout.

Colchicine has many potential side effects. First, it should never be given inravenously!! Second, when it is given to treat an acute attack, it may cause diarrhea, vomiting which can lead to dehydration and electrolyte imbalance.

Excessive dosing can lead to kidney failure, bone marrow suppression, low calcium, heart failure, lung failure, seizures, liver failure, rashes, hair loss, and death.

Older age and kidney dysfunction are risk factors for colchicine toxicity.

Colchicine can cause severe muscle damage.

Drug interaction is also a problem. There is an increased risk of kidney damage and muscle disease when cyclosporine is also being taken by the patient. This is particularly a problem because kidney transplant patients receiving cyclosporine are at increased risk for developing gout.

Drugs such as erythromycin, oral anti-diabetic drugs, and ulcer medicines like cimetidine (Tagamet) may increase colchicine blood levels.

Patients taking colchicine regularly should have periodic monitoring, including complete blood cell count, liver and kidney function, and urinalysis monthly for the first three months, then every three months.

Probenecid (Benemid):

Probenecid is a drug that increases the excretion of uric acid in the urine. It works by blocking the absorption of uric acid by the kidney. It is indicated for patients who do not already over-excrete urinary uric acid. This drug should be started during a stable period- not during an acute attack.

It is started at a dose of 500 mgs a day and then increased to 500 mgs twice daily. The aim is to keep the serum uric acid below 5.5 mgs/dl.

Prophylactic colchicine is used during the first six months of therapy.

Normal kidney function is required for probenecid to be effective. Also the patient must maintain good urine flow by drinking plenty of fluid (2 liters a day).

Probenecid should not be used in patients who have a history of kidney stones.

Low dose aspirin can inhibit the effectiveness of probenecid and therefore should be avoided. Keeping the urine alkaline may be helpful.

The most common side effects are rash and gastrointestinal upset. Other side effects are headache, bone marrow suppression, and kidney damage.

Increased levels of methotrexate and penicillin, leading to drug toxicity, can occur in patients who take probenecid.

Allopurinol (Zyloprim):

Allopurinol is a drug that blocks xanthine oxidase, an enzyme responsible for the production of purines. It is used in the prophylaxis of gout attacks. It is also used for the treatment of chronic gout, uric acid kidney stones, and for patients who have extremely high levels of uric acid.

Dosing should start at 100 mgs per day for a week, then 200 mgs a day for a eek, then finally 300 mgs a day as a maintenance dose. The dose may go higher than this. The aim is to keep the serum uric acid below 5.5 to 6 mg/dl. It should be started during a stable period and during an acute attack.

Allopurinol has many side-effects and precautions.

Elderly patients with reduced kidney function are most likely to run into problems with side effects. In patients with reduced kidney function, the dose of allopurinol needs to be adjusted downward.

Common side effects include rash, heartburn, headache, and diarrhea. A particularly severe hypersensitivity syndrome can occur with patients showing fever, hives, elevated white blood cell count, inflammation of the kidneys, kidney failure, hepatitis, and sloughing of the skin.

Drug interactions are common and dangerous. Concomitant ampicillin and allopurinol use leads to rash. The effects of anticoagulants such as warfarin may be increased when used with allopurinol. Thiazide diuretics increase the likelihood of allopurinol toxicity. Azathioprine toxicity can develop quickly because allopurinol reduces the metabolism of this drug. Alcohol decreases the effectiveness of allopurinol.

Allopurinol needs to be taken every day to be effective. When allopurinol is started, prophylactic colchicine may need to be used for the first six months of treatment.

Monitoring should be done monthly for the first three months, then every three months thereafter. Complete blood cell count, kidney and liver function, and urinalysis are recommended.

Others

Anturane is a drug that blocks platelet function and also has the desired effect of lowering serum uric acid. It's an old drug that is difficult to find.

Losartan (Cozaar) is a blood pressure medicine that also lowers uric acid.

Febuxostat (Uloric) works like allopurinol but has less potential for allergic reactions.

It is administered as either a 40 mg or 80 mg dose. Patients with kidney dysfunction are at increased risk of side effects. There may also be an increased tendency to cardiovascular events with high dose febuxostat.

PEG-uricase (Krystexxa) is given intravenously and converts purines to allantoin, a relatively harmless product. Allantoin is excreted through the urine. This drug is reserved for patients who have failed other drugs or in whom tophi are present. Tophi are large collections of uric acid.




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