II. Indications
-
Gouty Arthritis
- Uric Acid under-excreter (Urine Uric Acid < 700 mg/24h)
III. Contraindications
- Age >60 years
- Decreased Renal Function (esp. GFR <30 ml/min)
- Nephrolithiasis
- Over-production of Uric Acid
IV. Mechanism
- Uricosurics act at the renal tubule to decrease renal reabsorption and increase excretion of Uric Acid
V. Medications
- Use concurrent NSAID or Colchicine when starting
-
Probenecid (Consider Allopurinol instead)
- Dose: 250 mg orally twice daily
- Maximum: 1500 mg orally twice daily
- Sulfapyrazine (Rarely used)
- Dose: 50 mg orally twice daily
- Maximum: 100 mg orally twice daily
-
Lesinurad (Zurampic)
- Dose: 200 mg orally each morning
- Risk of Acute Renal Failure (should not be used as Uric Acid monotherapy)
- Must be taken with Xanthine Oxidase Inhibitor (Allopurinol or Febuxostat)
- Allopurinol dose must be at least 300 mg/day (at least 200 if CrCl <60 ml/min)
- Available as Duzallo (Allopurinol with Lesinurad)
- As of 2017, costs $12/day (compared with $3/day for Allopurinol and probenacid)
- (2017) Presc Lett 24(11): 64