49) Note: Related drugs included aspirin, sulfinpyrazone
, and ticlopidine.
13) Unequivocally, benzbromarone, probenecid, losartan, sulfinpyrazone
, and high doses of salicylates elevate uricosuric activity primarily through inhibition of URAT1.
John's Wort Primidone Sulfinpyrazone
Weak/moderate Nefazodone Quinidine inhibitors Nevirapine Ranitidine Norfloxacin Sertindole Norfluoxetine Troleandomycin Omeprazole Verapamil Paroxetine Zafirlukast Propoxyphene Zileuton Strong inhibitors * Ketoconazole Ritonavir Nelfinavir Saquinavir * Requires dosage modification when used in combination with PDE5 inhibitor.
Underexcretion hyperuricemia; and allergy, intolerance, or contraindications to both probenecid and sulfinpyrazone
Pharmacologic therapies include 1) uricosurics, such as probenecid, sulfinpyrazone
and benzbromarone (used mostly in Europe), which increase the renal clearance of uric acid, 2) xanthine oxidase inhibitors such as allopurinol, which limit the formation of uric acid to yield a more water soluble chemical, and 3) anti-inflammatory medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine.
Drugs such as trimethoprim-sulfathiazole (TMP-sulfa), erythromycin, cimetidine, metronidazole, ketoconazole, fluconazole, itraconazole, amiodarone, and sulfinpyrazone
all decrease the warfarin metabolism, which can increase prothrombin times and raise the international normalized ratio (INR).
If these agents are ineffective, or if patients develop tophi or kidney stones, consider adding a second agent that can lower the serum level of uric acid to below 7 mg/dL: allopurinol, probenecid, or sulfinpyrazone
16] Drugs that potentiate warfarin's anticoagulant effect include amiodarone, androgens, cimetidine,[19,20] clofibrate, disulfiram, metronidazole, phenylbutazone,[24,25] sulfinpyrazone
, thyroxine, and trimethoprim-sulfamethoxazole.
Myers et al (9) in 1987 reported on a large multicenter trial of aspirin and sulfinpyrazone
for unstable angina.