Uricosuric agents for gout

Examples

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Chemical Name

benzbromarone (used in Europe)

Brand Name	Chemical Name
Benemid	probenecid

Brand Name	Chemical Name
Anturane	sulfinpyrazone

How It Works

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Uricosuric agents lower uric acid levels in the body by increasing the elimination of uric acid by the kidneys.

Why It Is Used

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Uricosuric agents are used to lower the uric acid level in the blood and to prevent the formation of uric acid crystals in your joints and kidneys. They are also used to reduce the frequency of recurrences of acute gout.¹

Uricosuric agents are never started during a gout attack, but they should be continued if you are already taking them.

Uricosuric agents are not recommended for people who:

• Are having symptoms caused by a gout attack.
• Have urinary tract stones or a urinary tract obstruction.
• Have hyperuricemia and are undergoing chemotherapy or radiation treatment for cancer.
• Are taking moderate doses of aspirin.
• Have kidney failure or kidney disease.

How Well It Works

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Uricosuric agents can lower uric acid levels in people with hyperuricemia and gout. Continuous use of uricosuric agents lowers uric acid levels and reduces both the chance of forming and the size of gritty, chalklike clumps of uric acid crystals (tophi).² However, up to 25% of people using uricosuric agents to lower uric acid levels do not have adequate results.³

Side Effects

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Common, mild side effects include:

• Headache.
• Rash.
• Kidney stone formation (may be avoided by drinking more fluids).
• Stomach problems.

Rare, serious side effects include bone marrow problems.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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• Uricosuric agents should not be used until the symptoms of a gout attack are gone. However, if you are already taking these medications, you should continue to take them, even during an attack.
• Gout attacks may increase at first for some people taking probenecid. To avoid this, doctors may prescribe colchicine or low-dose nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce the inflammation caused by uric acid crystals, to be taken at the same time. After normal uric acid levels have been maintained for 6 to 12 months and no further attacks occur, colchicine or NSAIDs usually do not need to be taken.
• These medications can be taken with milk or food to reduce the chance of stomach irritation. (They should not be taken with antacids.)
• While taking these medications, drink more fluids to prevent the risk of kidney stones.

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References

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Citations

1. Hellman DB, Stone JH (2005). Arthritis and musculoskeletal disorders. In LM Tierney Jr et al., eds., Current Medical Diagnosis and Treatment, 44th ed., pp. 781–789. New York: McGraw-Hill.

2. Wortmann RL, Kelley WN (2005). Gout and hyperuricemia. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., pp. 1402–1429. Philadelphia: Elsevier Saunders.

3. Wise C (2004). Crystal-induced joint disease. In DC Dale, DD Federman, eds., Scientific American Medicine, section 15, chap. 9. New York: WebMD.

Credits

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Author	Jan Nissl, RN, BS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	July 24, 2006