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Medications To Treat Gout Include Agents And Allopurinol

Dosage For Elevated Serum Uric Acid Levels Due To Cancer Treatments

Allopurinol Treats Gout, Uric Acid Levels and Kidney Stones – Overview

Adult dosage

600800 mg per day for 2 or 3 days.

Child dosage

600800 mg per day for 2 or 3 days

Child dosage

300 mg per day. Your doctor will adjust your dose as needed based on your serum uric acid level.

Child dosage

150 mg per day. Your doctor will adjust your childs dose as needed based on your serum uric acid level.

Senior dosage

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

  • For people with kidney disease: Depending on how well your kidneys are working, your doctor will lower your dose. Your doctor will decide your dosage based on your creatinine clearance. This is a test that measures your kidney function.

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.

Action After Intake Pharmacokinetics

The following steps are involved in the pharmacokinetics of colchicine :

1. Absorption

Colchicine is absorbed when given orally to healthy subjects and reaches a mean Cmax of 2.5 ng/mL after one or two hours following a single dosage given under fasting conditions. Colchicine is readily absorbed when it is given orally as 1.8 mg colchicine over one hour to healthy young subjects under fasting conditions. Colchicine is readily absorbed in such a case and reaches a maximum plasma concentration of 6.2 ng/mL with a median 1.81 hours. The mean plasma concentration after the oral administration of the drug at high dose was 6.8 ng/mL with a median of 4.47 hours. The peak concentrations reach from 3.1 to 3.6 ng/mL after 10 days of giving 0.6 mg twice on daily basis.

Taking colchicine with food has no effect on rate of the absorption of colchicine but it decreases the extent of colchicine by 15%.

2. Distribution

The apparent mean volume of distribution in healthy young adults is about 5 to 8 L/kg. The binding of colchicine to serum protein is quite low which is 39+-5 due to albumin, regardless of the concentration. Colchicine crosses the placenta. It also distributes in the breast milk at concentrations similar to those found in maternal serum.

3. Metabolism

4. Elimination

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What Is The Safest Gout Medication

This cannot be inferred without the necessary information such as your health condition, medications you are currently on and your current lifestyle. Your doctor will be able to prescribe the safest medication for you, provided you advise them accordingly.

References:

Gøtzsche PC . Non-steroidal anti-inflammatory drugs, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Teichman JMH . Acute renal colic from ureteral calculus. New England Journal of Medicine, 350: 684â693.

Wise C . Crystal-induced joint disease. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 9. New York: WebMD.

Learn About Gout

Diagnosis Treatment And Prevention Of Gout

Allopurinol and Gout

BARRY L. HAINER, MD ERIC MATHESON, MD and R. TRAVIS WILKES, MD, Medical University of South Carolina, Charleston, South Carolina

Am Fam Physician. 2014 Dec 15 90:831-836.

Gout is the most common inflammatory arthropathy, affecting more than 8 million Americans.1 Gout accounts for approximately 7 million ambulatory visits in the United States annually at a cost of nearly $1 billion.2 Risk factors include genetics, age, sex, and diet.2,3 These factors may contribute to a high serum uric acid level, which is currently defined as a value of at least 6.8 mg per dL .4,5

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Oral corticosteroids and nonsteroidal anti-inflammatory drugs are equally effective in the treatment of acute gout.

Clinical recommendation

35, 36

To prevent recurrent gout, patients should reduce their consumption of high-fructose corn syrupsweetened soft drinks, fruit juices, and fructose-rich vegetables and fruits . Reducing consumption of meat and seafood, and increasing consumption of dairy products help reduce the frequency of gouty symptoms. Consumption of low-fat or nonfat dairy products may help reduce the frequency of flares.

A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .

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What Medication To Avoid With Gout

It is best to discuss with your doctor the medications that should not be taken with gout. An over-the-counter medication to avoid is aspirin as it can exacerbate your gout attack and increase uric acid levels. Other medications such as those that treat high blood pressure, heart failure or diuretics can interact negatively with gout and gout medications. Speak to your doctor about other concerns.

Allopurinol And Other Medications

Below are examples of medications that can interact with allopurinol oral tablets. This section does not contain all drugs that may interact with allopurinol.

Before taking allopurinol oral tablets, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drugs that can affect how allopurinol oral tablets work include:

  • Salicylates, which can cause the opposite effect of allopurinol and prevent it from lowering uric acid levels. Examples of these drugs include:
  • bismuth subsalicylate

Allopurinol oral tablets can affect how other drugs work. If you take one of the following drugs, you may need a lower dose than usual if you also take allopurinol:

Some medications can increase your risk for certain side effects.* These drugs include:

  • Amoxicillin , which has been reported to increase the risk of skin rash when used in combination with allopurinol.
  • Thiazide diuretics, which can increase the risk of kidney problems, especially in people with kidney disease. Examples of thiazide diuretics include:

* For more information about side effects, see the Allopurinol oral tablet side effects section above.

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Allopurinol Oral Tablets And Breastfeeding

It is not recommended that you breastfeed while taking allopurinol oral tablets. The drug passes into breast milk and may harm a child who is breastfed.

If youre breastfeeding or planning to breastfeed, talk with your doctor. They may suggest a different medication. But if your condition is severe, your doctor may recommend a different feeding option so that you can start treatment.

Do not take more allopurinol oral tablets than your doctor recommends. For some drugs, doing so may lead to unwanted side effects or overdose.

Should I Stop Taking Allopurinol During A Gout Attack

Allopurinol – How it works in treatment of GOUT

You should not stop taking allopurinol oral tablets during a gout attack. If you suddenly stop taking the drug, the uric acid level in your blood can rise. When your uric acid level is high, your gout symptoms may become worse.

If you have gout attacks during your treatment, talk with your doctor. They may be able to recommend other medications that could help. Keep in mind that you should not stop taking allopurinol oral tablets without first talking with your doctor.

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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

What Other Information Should I Know

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body’s response to allopurinol.

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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Who Can Take Allopurinol

Allopurinol is often recommended as the first choice of treatment to control gout. If your doctor prescribes it as soon as you are diagnosed, it may prevent future attacks and joint damage.

You will usually be offered allopurinol if blood tests show that your urate level is high enough for urate crystals to form, especially if one or more of the following applies:

  • you are having frequent attacks of gout.
  • your joints have been damaged by gout.
  • your skin has visible deposits of urate crystals. These are firm white lumps, which are called tophi.

You may not be offered allopurinol, or you may be given a lower dose, if you:

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

    Effects On Other Treatments

    2009 gout pharmacology

    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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    Mechanism Of Allopurinol Pharmacokinetics

    The following steps take place after the intake of allopurinol :

    1. Absorption

    The peak plasma concentrations of allopurinol after 80 to 90 percent absorption are reached after 1.5 to 4 hours. The infusion takes place over 30 minutes and the peak plasma concentration of allopurinol is reached in about 30 minutes.

    The serum urate concentrations in patients suffering from gout decreases slowly within 24 to 48 hours. The minimum concentrations may not reach for about one to three weeks. The substantial uric acid may be delayed up to 6 to 12 hours because of the continuous mobilization of the urate deposits.

    People who suffer from geriatric disease have greater peak plasma concentrations and the allopurinol dosage in such patients is 50 to 60 percent higher than in young adults which is related to the renal function in older population.

    2. Distribution

    Allopurinol is uniformly distributed throughout the body except the brain where the concentrations are about 50% of the concentrations in other tissues. Allopurinol is distributed into the milk. Allopurinol isnt bound to plasma proteins.

    3. Metabolism

    Allopurinol is metabolized by xanthine oxidase and it is metabolized to an active metabolite known as oxypurinol.

    4. Elimination

    The drug is excreted through urine and feces as an unchanged drug within 48 to 72 hours. Allopurinol is dialyzable. The half-life of allopurinol is about 1-3 hours.

    Uricosuric Medications For Chronic Gout

    Background – what is chronic gout and what are uricosuric medications?

    Chronic gout is a type of inflammatory arthritis caused by high levels of uric acid in the blood leading to crystal formation in the joints and repeated attacks of acute gout. Treatment of chronic gout can make acute gout attacks less likely.

    Uricosuric medications work to lower blood uric acid levels by increasing the amount of uric acid that is eliminated via the kidneys.

    Study characteristics

    This summary of a Cochrane review presents what we know from research about the effect of uricosuric medications for treating chronic gout. After searching for all relevant studies to May 2013, we found five studies. Most participants in these studies were male , aged between 50 and 70 years and did not have significant kidney or liver disease. Two trials compared benzbromarone with allopurinol, two trials compared benzbromarone with probenecid and one trial compared allopurinol with probenecid. We found no studies comparing uricosuric medications with placebo, or with newer urate-lowering therapies such as febuxostat or pegloticase. We restricted reporting of results here to benzbromarone versus allopurinol, as allopurinol is a commonly used first-line treatment for gout.

    Key resultswhat happens to people with chronic gout who take uricosuric medications

    Benzbromarone compared with allopurinol:

    Acute gout attacks:

    – 4 people out of 100 on benzbromarone had acute gout attacks.

    Withdrawal due to side effects:

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    The Role Of Diet In Gout Prevention

    Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL

    For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4

    Do Side Effects Of Allopurinol Vary By The Tablet Strength

    Allopurinol (Zyloprim)

    Its possible that some side effects of allopurinol may be more severe or more likely to occur with a high strength. But your doctor wont start your treatment with a high strength of the drug. Instead, theyll typically start you with a low dosage and slowly increase it over time.

    If you develop a skin rash or other serious side effects at any dose, your doctor will have you stop taking allopurinol oral tablets.

    If you have other questions about the side effects of allopurinol oral tablets, talk with your doctor or pharmacist.

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    Uricosuric Agents: Probenecid And Sulfinpyrazone

    Probenecid and Sulfinpyrazone are used in gout therapy to help prevent further attacks of gout.

    These drugs are not given during an acute gout attack but are primarily used to prevent recurrence after the acute attack of gouty arthritis has subsided.

    They are, however, continued even during an acute attack if the patient is already taking them. These drugs help to prevent gout attacks but do not cure the gout attack. Required results are obtained in only 75% of the cases.

    These drugs lower serum uric acid levels by increasing the excretion of uric acid through the urine. They thus prevent the formation of uric acid crystals in the joints.

    These gout medicines are contraindicated

    • in patients having kidney disease or stones in the genitourinary tract,
    • in cancer patients who are on radiotherapy and/or chemotherapy,
    • those on maintenance doses of aspirin.

    Allopurinol Oral Tablets For Treating Gout

    Allopurinol oral tablets are FDA-approved to treat a common type of arthritis called gout. The drug is considered a maintenance treatment for gout. Over time, it can help prevent acute gout . But its not used to treat sudden gout attacks.

    Gout explained

    Gout can cause pain, stiffness, and swelling in a joint, usually your big toe.

    Gout occurs when your blood has too much of a waste product known as uric acid. Gout attacks are sudden, temporary flare-ups of severe pain and swelling. They usually go away in 1 or 2 weeks with treatment, which includes using drugs other than allopurinol. But gout attacks can keep coming back over time.

    Effectiveness for treating gout

    Clinical studies show that allopurinol oral tablets are effective for helping prevent gout attacks. The drug works by reducing uric acid levels in your body, which may take several weeks.

    The American College of Rheumatology recommends the use of allopurinol in their treatment guidelines for gout.

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    Some Side Effects Can Be Serious The Following Symptoms Are Uncommon But If You Experience Any Of Them Call Your Doctor Immediately:

    • skin rash
    • swelling of the lips or mouth
    • fever, sore throat, chills, and other signs of infection
    • loss of appetite
    • unexpected weight loss
    • itching

    Allopurinol may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .

    Taking Allopurinol With Painkillers

    Gout: A Clinical Review

    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.

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