Info

🌱 來自: gout

Urate-Lowering Therapy

• Allopurinol (PO)

  • Mechanism: Xanthine oxidase inhibitor
  • Comments: 1st line; adjust starting dose in CKD; titrate ↑ q2-5wk; a/w rash, hypersensitivity syndrome (see below), BM suppression (avoid w/ AZA/6-MP), diarrhea, N/V, hepatitis; monitor CBC, LFT’s; not nephrotoxic; max dose = 800 mg/d

• Febuxostat (PO)

  • Mechanism: Nonpurine xanthine oxidase inhibitor
  • Comments: 2nd line; use if allopurinol intolerant; a/w ↑ LFT, rash, arthralgias, N/V; avoid w/ AZA/6-MP (BM suppress); start 40 mg, max dose = 120 mg/d

• Pegloticase (IV)

  • Mechanism: Recombinant uricase
  • Comments: For refractory tophaceous gout; infusion reactions (including anaphylaxis); Ab formation may limit use (JAMA 2011;306:711); avoid w/ G6PD deficiency

• Probenecid (PO)

  • Mechanism: Uricosuric
  • Comments: Rarely used; risk of urolithiasis

Note: PO stands for oral administration, and IV stands for intravenous administration. The “a/w” in the comments indicates “associated with.”