Sunday, August 14, 2022

Drug Of Choice For Gout

What Should I Do If I Forget A Dose

Drugs of Choice -(Disease -drug correlation guide)

Take the missed dose as soon as you remember it. If you are taking colchicine on a regular basis and it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

However, if you are taking colchicine to treat an attack of gout that happened while you were taking colchicine to prevent gout attacks and you forget to take the second dose, take the missed dose as soon as you remember it. Then wait at least 12 hours before taking your next scheduled dose of colchicine.

Risk Factors For Gout

Gout is more likely to occur in:

  • Men. Men have a seven to nine times higher risk of gout than women, although the risk increases for women after menopause
  • People with a diet high in purine-rich foods such as red meat, organ meats , seafood . Processed foods , refined carbohydrates and beverages high in fructose or sucrose also contribute to gout
  • Certain ethnicities
  • People who overindulge in alcohol, particularly beer and spirits
  • People with certain medical conditions , and with some medications or treatments .

How Is It Taken

Allopurinol is taken as a tablet once a day. It is usually better to take it just after eating and the tablet should be swallowed with water. It is important to drink plenty of water during the day because this will help you get rid of more urate through your kidneys.

Your dose of allopurinol may change over time, depending on the amount of urate in your body. Your doctor will monitor your urate levels with blood tests every 2-4 weeks, until they are sure that the dose that youre taking is high enough to reduce the amount of urate in your body.

You may need to remain on a lower dose if you have kidney or liver problems.

Your doctor may recommend that you do not start taking allopurinol until after an attack of gout has passed to avoid triggering further attacks. If this is not possible, it may be started when your inflammation is not too bad.

Allopurinol doesnt treat the immediate pain caused by attacks of gout. But its a long-term treatment to get rid of the urate crystals which causes gout attacks.

It is likely that you will need to take allopurinol for the rest of your life to manage your urate levels. You should keep taking allopurinol even if:

  • you are experiencing more gout attacks, or it doesnt seem to help the pain and inflammation at first
  • you stop having gout attacks stopping your treatment can cause urate crystals to form again, which will lead to more gout attacks.
  • etoricoxib

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    Medication Options For Uric Acid Lowering

    It is important to note that whenever starting a uric acid lowering treatment, there is a risk of precipitating a gout flare. A plan should be in place for management if this occurs. This generally can be avoided with the co-administration of prophylactic medications along with the uric acid lowering therapy.

    Probenecid

    Probenecid may be given to patients with decreased clearance of uric acid by the kidney and normal renal function. In general its use should be limited to patients under the age of 60. Probenecid acts by inhibiting reabsorption of uric acid in the proximal tubules of the kidney. Starting dose is at 500 mg to 1000 mg daily and increased to 1500 mg to 2000 mg as needed. Occasionally higher doses are needed. Probenecid may precipitate renal stone formation and good oral hydration should be encouraged. Probenecid is contraindicated in patients with renal stones and in patients with urate nephropathy. Probenecid given inappropriately to patients with hyperuricemia due to overproduction of uric acid can cause renal stones and urate nephropathy.

    • uricosuric
    • useful in patients with decreased renal clearance of uric acid
    • can only be used if creatinine clearance > 40 cc/min
    • must have 24 hour urine for uric acid < 800 mg/dl
    • can be used in renal failure
    • increased risk of renal stones

    Allopurinol

    Pegloticase

    • pegylated porcine uricase

    Effects On Other Treatments

    PPT

    Some drugs interact with allopurinol, so you should discuss any new medication with your doctor before starting it. You should also tell anyone else treating you that youre taking allopurinol.

    Do not use complementary treatments, such as herbal remedies, without discussing this first with your doctor or pharmacist. Some of them could react with allopurinol.

    You should avoid taking aspirin while youre being treated for gout. If youre in pain, you can take paracetamol and NSAIDs. But remember you should only take one NSAID at a time so do not take another if you have already been prescribed one to reduce the effects of gout attacks.

    Allopurinol can also react with drugs that are often prescribed for high blood pressure, such as bendroflumethiazide, indapamide, lisinopril, ramipril.

    Allopurinol reduces the breakdown of azathioprine, which is used to treat conditions such as rheumatoid arthritis and lupus. Your doctor may change your dose of azathioprine to account for this.

    It can also reduce the breakdown of the leukaemia drug mercaptopurine, so the dose of mercaptopurine will need to be reduced if you take this drug.

    Allopurinol may also increase the risk of developing a rash if you take them with the antibiotics ampicillin or amoxicillin.

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    What Should I Know About Storage And Disposal Of This Medication

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .

    It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.

    Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.

    Important Information About Gout Medication

    If you are taking medication to lower uric acid, you need to take it every day, whether you are having an attack or not.

    Treatment is important to reduce gout attacks and avoid permanent joint damage. However, as all medicines have side effects, discuss medication choices with your doctor by asking:

    • what are the benefits of gout medication?
    • what are the risks of this medication?
    • what are the side effects?

    Always let your doctor or pharmacist know what medicines you are taking to avoid interactions. It is also a good idea to discuss if you want to stop or change the dose of your medications.

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    Medicines That Block Uric Acid Production

    • How they work: These medications limit the amount of uric acid your body makes.
    • Risks: Acute attacks or ‘flares’
    • Doctors sometimes delay the start of these medications for at least a week after the acute gout has settled because they may actually make a gout attack last longer, or trigger acute attacks at the start of treatment.
    • To reduce the risk of such acute flares of gout your doctor may prescribe a small dose of colchicine, or an NSAID, for 3-6 months after starting treatment with allopurinol or febuxostat.

    Oral Gout Medicines Dont:

    Pharmacology 248 c Allopurinol Gout Gouty Arthritis Hyperurecemia Uric Xanthine
    • CONVERT URIC ACID: KRYSTEXXA is the only gout treatment that controls by changing uric acid into a water-soluble substance called allantoin that your body easily gets rid of through urine.
    • SIGNIFICANTLY LOWER YOUR URIC ACID LEVEL IN 24 HOURS: After just one IV treatment, KRYSTEXXA starts to lower your uric acid level enough to begin dissolving years of uric acid crystal buildup and .
    • DISSOLVE YEARS OF GOUT BUILDUP IN JUST MONTHS: It can take more than two years for oral gout medicines to dissolve even a small amount of uric acid crystal buildup. KRYSTEXXA can dissolve most of it in about 6 months.

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    Taking Allopurinol With Painkillers

    You can take allopurinol with paracetamol and anti-inflammatory medicines such as ibuprofen, naproxen, or indomethacin.

    Your doctor may prescribe a NSAID (such as diclofenac or naproxen or a medicine called colchicine to help prevent or to deal with attacks of gout especially in the early stages of allopurinol treatment.

    Get Answers Advice And Medicine

    The pain from a gout attack usually gets better in 3 to 10 days. But youâll feel better faster if the gout is treated. If you think you might have it, contact your doctor. An exam and tests will show if itâs gout or something else, like an infection.

    Talk with your doctor about the best medicines for you. The type will depend on how well your kidneys work, the possible side effects, and other health issues.

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    What Other Information Should I Know

    Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to colchicine.

    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

    It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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    PPT

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    How Should This Medicine Be Used

    Colchicine comes as a tablet and solution to take by mouth with or without food. When colchicine is used to prevent gout attacks or to treat FMF, it is usually taken once or twice a day. When colchicine is used to relieve the pain of a gout attack, one dose is usually taken at the first sign of pain and a second, smaller dose is usually taken one hour later. If you do not experience relief or have another attack within several days after treatment, talk to your doctor before taking additional doses of medication. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take colchicine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

    It is important to use an oral syringe to accurately measure the correct amount of liquid for each dose do not use a household spoon.

    If you are taking colchicine to treat FMF, your doctor may start you on a low dose and gradually increase your dose. Your doctor may decrease your dose if you experience side effects.

    Colchicine can prevent attacks of gout and control FMF only as long as you take the medication. Continue to take colchicine even if you feel well. Do not stop taking colchicine without talking to your doctor.

    How To Take It

    Swallow the allopurinol tablets with water, ideally after food. You’ll usually take it once a day, but if you’re on a high dose, your doctor may advise you to split the dose and take it twice a day.

    If your doctor has recommended you take allopurinol with lots of fluid, try to drink 2 to 3 litres of fluids every day.

    You can take allopurinol at any time of the day, however, try to take your doses at the same time of day each day.

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    How And When To Take It

    The usual dose of allopurinol is 100mg to 300mg a day. Follow your doctor’s advice on how many tablets to take, and how many times a day.

    You’ll have regular blood tests to monitor your uric acid levels. If your uric acid level does not come down far enough, your doctor may increase your dose .

    If you have kidney or liver disease, your doctor may prescribe a lower dose and will monitor you more closely.

    How Krystexxa Works Inside The Body

    Drug Of Choice ( DOC ) Autacoids || Mis.Medicine

    KRYSTEXXA is a prescription medicine used in adults to help reduce the signs and symptoms of gout that are not controlled by other treatments.

    Intended for U.S residents only.

    What is the most important information I should know about KRYSTEXXA ?

    Serious allergic reactions may happen in some patients who receive KRYSTEXXA. These allergic reactions can be life threatening and usually happen within 2 hours of the infusion.

    USE

    KRYSTEXXA is a prescription medicine used in adults to help reduce the signs and symptoms of gout that are not controlled by other treatments.

    IMPORTANT SAFETY INFORMATION

    What is the most important information I should know about KRYSTEXXA ?

    Serious allergic reactions may happen in some patients who receive KRYSTEXXA. These allergic reactions can be life threatening and usually happen within 2 hours of the infusion.

    KRYSTEXXA should be given to you by a doctor or nurse in a healthcare setting where serious allergic reactions can be treated. Your doctor or nurse should watch you for any signs of a serious allergic reaction during and after your treatment with KRYSTEXXA.

    Tell your doctor or nurse right away if you have any of these symptoms during or after your treatment with KRYSTEXXA:

    Who should not receive KRYSTEXXA?

    Do not receive KRYSTEXXA if you have a rare blood problem called glucose 6-phosphate dehydrogenase deficiency or favism. Your doctor should test you for G6PD before you start KRYSTEXXA.

    What are the possible side effects of KRYSTEXXA?

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    Why Is This Medication Prescribed

    Colchicine is used to prevent gout attacks in adults. Colchicine is also used to relieve the pain of gout attacks when they occur. Colchicine is also used to treat familial Mediterranean fever in adults and children 4 years of age and older. Colchicine is not a pain reliever and cannot be used to treat pain that is not caused by gout or FMF. Colchicine is in a class of medications called anti-gout agents. It works by stopping the natural processes that cause swelling and other symptoms of gout and FMF.

    Role Of The Pharmacist

    Pharmacists play an integral role in patient education andimproving the care of patients with gout. They can help patientsimprove adherence to pharmacologic and nonpharmacologic therapies.Pharmacists should emphasize lifestyle modifications and diet such asmanaging weight, limiting meat and seafood intake, and minimizingalcohol intake. Pharmacists should also educate patients about theirgout medications, including appropriate dosing, duration of therapy,adverse effects, contraindications, and drug interactions.

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    Pharmacologic Management Of Gout

    Manouchkathe Cassagnol, PharmD, BCPS, CGPAssistant Clinical Professor

    Maha Saad, PharmD, BCPS, CGPAssistant Clinical ProfessorQueens, New York

    US Pharm

    ABSTRACT:Gout is a rheumatic disease thatresults from an excess body burden of uric acid, or hyperuricemia, whichcommonly manifests as recurrent episodes of acute joint pain andinflammation secondary to the deposition of monosodium urate crystals,or tophi, in the synovial fluid and lining. Hyperuricemia is caused byan increased production or a decreased excretion of uric acid, or both.Treatment of gout involves managing hyperuricemia with urate-loweringtherapy and of acute goutyarthritis with colchicine, nonsteroidal anti-inflammatory drugs, and/orcorticosteroids. Pharmacists play an integral role in patient educationand improving the care of patients with gout.

    Gout is the most common rheumatic disease of adulthood,with a self-reported prevalence of more than 8 million cases in theUnited States, affecting 3.9% of adults, with a male-to-female ratio of3:1.5 However, at an older age the incidence of gout in women approaches the incidence in men.6

    New gout guidelines from the American College ofRheumatology have been recently published focusing on the use ofurate-lowering therapy , analgesic and anti-inflammatorymedications for the management of acute gouty arthritis, and drugprophylaxis of acute attacks .1,7

    Hepatic Impairment And Gi Bleeding

    What are the causes and treatments of gout?

    Patients with cirrhosis should avoid NSAID use due to the potential increased bleeding risk from underlying coagulopathy. Additionally, colchicine clearance may be reduced in patients with severe liver impairment, mandating close surveillance when this agent is used. If hepatic impairment is mild to moderate, judicious use of any of the first-line therapies may be appropriate.

    Patients with GI bleeding or a history of peptic ulcer disease should avoid NSAID use because of increased bleeding risk. If an NSAID is used, proton pump inhibitors decrease the risk of NSAID-associated mucosal damage.

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    Who Can And Cannot Take Allopurinol

    Allopurinol can be taken by adults and sometimes children.

    Allopurinol is not suitable for certain people.

    Talk to a doctor or pharmacist if you:

    • have ever had an allergic reaction to allopurinol or any other medicine
    • are of Han Chinese, Thai or Korean origin
    • have problems with your liver or kidneys
    • currently have an attack of gout
    • have thyroid problems

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