"A Randomized Trial of Aspirin and Sulfinpyrazone
in Patients with TIA." Stroke, 13(2): 175-98.
The AWP of a month supply of brand name (Anturane) and generic sulfinpyrazone
in 1991 was $48.25 and $28.45, respectively (Medical Economics Company 1991).
Certain drugs may increase the hypoglycemic effect of the sulfonylureas including: androgens, anticoagulants, chloramphenicol, clofibrate, fenfluramine, fluconazole, gemfibrozil, histamine [H.sub.2] blockers, magnesium salts, methyldopa, MAO inhibitors, phenylbutazone, probenecid, salicylates, sulfinpyrazone
, sulfonamides, tricyclic antidepressants, and urinary acidifiers.
Sulfinpyrazone use is problematic, given its side effects and drug interactions, and sulfinpyrazone is not universally available.
(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
. These drugs should not be started until an acute attack has ended because of the risk of mobilizing uric acid stores.
Examples of drugs that significantly reduce warfarin's anticoagulant effect include barbiturates[15 ]and rifampin. Drugs that potentiate warfarin's anticoagulant effect include amiodarone, androgens, cimetidine,[19,20] clofibrate, disulfiram, metronidazole, phenylbutazone,[24,25] sulfinpyrazone
, thyroxine, and trimethoprim-sulfamethoxazole. Some of these drugs are not used routinely today.
Fries and Loftus, (8) in an often quoted article, stated that explicit suggestion of possible adverse effects causes subjects to experience these effects." Myers et al (9) in 1987 reported on a large multicenter trial of aspirin and sulfinpyrazone
for unstable angina.