Fenofibrate, losartan, and atorvastatin are not FDA-approved for gout but act as uricosurics and can therefore be used to treat gout comorbidities or in association with xanthine oxidase inhibitors.
Available US Food and Drug Administration (FDA)-approved options for lowering sUA include xanthine oxidase inhibitors (allopurinol and febuxostat) that prevent production of uric acid; a uricosuric agent (probenecid) that increases uric acid output in urine; and a uric acid-specific enzyme (pegloticase) that converts uric acid to allantoin.
The treatment period with uricosurics ranged from 12 to 18 months.
Benzbromarone is an uricosuric agent that has been used for more than 25 years to control hyperuricemia .
* Using allopurinol first-line as urate-lowering therapy, and considering uricosurics
as alternatives when necessary.
(28) This protein is the target for most uricosuric
drugs, including probenecid, sulfinpyrazone, benzbromarone, and high-dose salicylates, as well as minor uricosurics
, such as losartan.
We discuss the therapeutic limitations of allopurinol and uricosurics
and the potential applications of novel xanthine oxidase inhibitors and of recombinant uricase preparations.
Kirn, writer Drug Cost/Day* Dosage URICOSURICS
probenecid $1.42 (500 mg 250 mg twice daily, taken with breakfast b.i.d.) and dinner, increased to achieve a serum urate level below 6 mg/dL, to a maximum of 3 g daily XANTHINE OXIDASE INHIBITORS allopurinol $0.17 (300 mg 300 mg once a day initially in patients once per day) with a creatinine clearance [Zyloprim] [$1.16 (300 mg [greater than or equal to]90 mL/min, once per day)] gradually titrated up in 50-mg or 100-mg increments every 2 weeks, until serum urate level drops below 6 mg/dL, to a maximum of 800 mg/day.
Drug Cost/Day * Dosage What the Experts Say ** URICOSURICS
probenecid $1.42 (500 250 mg twice Available in generic mg b.i.d.) daily, taken formulations only.
Some evidence suggests that despite their serum uric acid-lowering effects, uricosurics
(such as probenecid) fail to reduce gout attacks (SOR: B, based on 2 cohort studies).
* Overproduction / overexcretion hyperuricemia; when coupled with uricosurics
, this can increase the risk of renal stones.
* The patient requires prevention of malignancy-associated hyperuricemia and tumor lysis syndrome due to cytolytic therapy for hematologic malignancies; the resulting massive uricosuria precludes the use of uricosuric