gout

goal UA level for gout

<6

probenecid

CI - aspirin therapy decreased effectiveness CrCl < 30 don't use in G6PD deficiency can be used to increase beta lactam levels

colchicine

Colcrys two 0.6 mg tab then 0.6 mg in 1 hr can repeat q3days start w/in 36 hrs of symptoms CrCl <30 - don't redose until 2 weeks wait 12 hrs before restarting ppx

pegloticase

IV bbw: anaphylaxis, premedicate with steroids and antihistamines do not use in combo with allopurinol or febuxostat

indomethacin

Indocin avoid use in severe renal disease CVD risk

acute gout pain treatment

NSAIDs, steroids, colchicine

allopurinol

Zyloprim CrCl 10-20 - 200 mg max CrCl <10 - 100 max SJS, TEN - HLA-B*5801 testing prior can cause acute gout attack use with colchicine for first 3-6 mo

chronic treatment of gout

allopurinol or febuxostat xanthine oxidase inhibitors

allopurinol DDI

antacids decrease absorption increased levels mercaptopurin or azathioprine increased didanosine

drugs that increase uric acid

aspirin diuretics niacin pyrazinamide pancreatic enzyme calcineurin inhibitors tumor lysis syndrome

colchicine SE

diarrhea, nausea, myelosuppression, neuropathy, myopathy

normal uric acid

female - 2-6.5 male - 3.5-7.2

febuxostat

hepatotoxicity, increase thromboembolic events, SJS, TEN use with colchicine for first 3-6 mo

foods to avoid

organ meats, high-fructose corn syrup, alcohol

colchicine CI and warnings

use with Pgp and 3A4 inhibitors myelosuppression, GI sxs use w/ statins, nonDHP CCBs increase risk myopathy

lesinurad

use with allopurinol or febuxostat inhibits reabsorption uric acid in kidneys only initiate CrCl >45; CI CrCl<30 bbw acute renal failure