What are risk factors for gout?
- Male sex
- Obesity
- Excessive alcohol consumption (beer)
- HTN
- CKD
- Lead intoxication
- Advanced age
What are drugs that increase uric acid?
- ASA (lower doses)
- Tacrolimus, cyclosporine
- Diuretics (loops & thiazides)
- Niacin
- Pyrazinamide
- Select chemo
- Select pancreatic enzyme products
What drugs are used to treat acute gout?
Colchicine (Colcrys)
Steroids
NSAIDs
Colchicine dose for tx?
Renal dysfunction?
1.2 mg PO, followed by 0.6 mg in 1 hr. Max: 1.8 mg/1 hr or 2.4 mg/day
2.CrCl <30: same dose but do not give again x 2 weeks
Colchicine dose for prophy? Renal dose?
0.6 mg qd or bid
CrCl <30: 0.3 mg/day
Colchicine
Side effects & warnings
- Myelosuppression
- GI: diarrhea, nausea
- Myopathy, neuropathy
- Vit B12 decrease
Which meds should you not use colchicine with?
CYP3A4i & Pgpi
(cyclosporine, dilt, verap, gemfibrozil or statins)
When should you start colchicine for tx?
Within 36 hours of sx onset
When should you resume prophy dose of colchicine after tx?
12 hours
What should you do if using colchicine with strong CYP3A4i? Mod CYP3A4i?
Strong: dose is reduced, repeated no earlier than 3 days
Mod: max dose of tx 1.2 mg (2 tabs)
What is the usual & max dose of allopurinol (Zyloprim, Aloprim)? Renal dose?
Usual: 100 mg daily, doses >300 mg can be necessary
Crcl <30: start at 50 mg daily, increase to 300 mg/day
Allopurinol & febuxostat side effects?
- Rash
- Acute gout attacks (take with colchicine prophy dose or NSAID x 3-6 months when starting)
- Nausea, diarrhea
- Increased LFTs
Allopurinol warnings
- Hypersensitivity rxns
- HLA-B5801 testing prior to use if high risk
- Hepatotoxicity
- Bone marrow suppression
What is the usual, max & renal dose for febuxostat (Uloric)?
Usual: 40 mg daily
Max: 120 mg/day
Crcl <30: max 40 mg daily
Boxed warning for febuxostat?
- Increased risk of CV death
General warnings for febuxostat?
- Hepatotoxicity
- possible MI or stroke
- SJS/TEN
Which drugs should you not use XOI with?
- mercaptopurine
- azathioprine
- didanosine
- Antacids (lower allopurinol absorption)
Uricosurics (can be added with XOI)
What is usual & renal dose for Lesinurad (Zurampic)?
Usual: 200 mg daily
CrCl <30: CI, only initiate with CrCl at least 45
Boxed warnings for Zurampic?
Acute renal failure
Uricosurics used with XOI
What is the usual & renal dose for Probenecid (Probalan)?
Usual: 250 mg BID
Max: 2 g/day
CrCl <30: avoid
What are CI for probenecid?
Do not use in ASA therapy, blood dyscrasias, UA kidney stones, children <2, initiation in acute gout attack
What are SE of probenecid?
Hypersensitivity rxns, hemolytic anemia
Trivia of probenecid
- Do not use in G6PD deficiency
- Can be used to increase beta lactam levels by decreasing beta lactam excretion
- Also can increase MTX, ASA levels
- Decreases efficacy of loops, increases risk of loop toxicity
Recombinant uricase: converts uric acid to allantoin
What is Pegloticase (Krystexxa)?
Injection given 8 mg IV q2 weeks
