II. Indication

  1. Rarely used now due to toxicity
    1. Allopurinol used most often for gout prophylaxis
  2. Gout for Uric Acid under-excreter
    1. Indicated for Urine Uric Acid < 700 mg/24h

III. Mechanism

  1. Increases Uric Acid excretion in Gout

IV. Indications: Requirements for use

  1. Age <60 years
  2. Normal Renal Function
  3. No history of renal stone
  4. No overproduction of Uric Acid

V. Preparations

  1. Use concurrent NSAID or Colchicine when starting
  2. Probenecid (Consider Allopurinol instead)
    1. Dose: 250 mg PO bid
    2. Maximum: 1500 mg PO bid
  3. Sulfapyrazine (Rarely used)
    1. Dose: 50 mg PO bid
    2. Maximum: 100 mg PO bid
  4. Lesinurad (Zurampic)
    1. Dose: 200 mg orally each morning
    2. Risk of Acute Renal Failure (should not be used as Uric Acid monotherapy)
    3. Must be taken with Xanthine Oxidase Inhibitor (Allopurinol or Febuxostat)
      1. Allopurinol dose must be at least 300 mg/day (at least 200 if CrCl <60 ml/min)
    4. Available as Duzallo (Allopurinol with Lesinurad)
      1. As of 2017, costs $12/day (compared with $3/day for Allopurinol and probenacid)
    5. (2017) Presc Lett 24(11): 64

VI. Adverse effects

  1. Dermatitis
  2. Cytopenias
  3. Reduces excretion of other drugs (e.g. Penicillin)

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Related Studies

Cost: Medications

probenecid (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PROBENECID 500 MG TABLET Generic $0.55 each