Summary Therapeutic index explained

Class Drug Indications General Adverse reactions DIs
Colchicine  ↓ risk of flares (NOT joint  Diarrhea  Erythromycin
damage)  Nausea  Simvastatin
 ONLY when NSAIDS are CI  Myelosuppresion  Cyclosporin
 ↓ clearance in renal failure  Myopathy
(danger, renal impairment)  Rabdomyolysis
 Not 1st line due to severe AEs  Renal failure

Urate Allopurinol  Frequent attacks  Purine analogs
lowering  Tophaceous gout  Inhibits XO
 Gout with renal failure  Substrates of XO
 Recurrent stones  Thus blocking
 High serum urate levels hypoxanthinexanthineuric
(males 0.77Um/l, females acid
0.59Um/l)
 Urinary urate = >
6.5mmol/day

Newer Febuxostat  Treatment of chronic  Selective XO inhibitor  Liver toxicity?
therapies hyperuricaemia (conditions  Minimal excretion in the urine
where urate deposits has  Can administer in renal
already occurred) insufficiency and mild/moderate
 Management of chronic hepatic insufficiency with no
hyperuricaemia in gout in dosage adjustments
allopurinol is not tolerated or
CI

Uricosuric  Probenecid Mild uricosuric agents:
agents  Benzbromar  Losartan (Cozaar)
one (ex-US)  Fenofibrate
 Sulfinpyrazo
ne (ex-US)

Recombinan Rasburicase Recombinant porcine-like Pegloticase  ↓ risk of
t urate uricase Metabolizes: precipitates
oxidase Ric  Treat resistant gout
acidallantoin(m
ore soluble)