PEBC: What You Need to Know: Uric Acid Lowering Therapies

Examples: Allopurinol, Febuxostat

Indication:

Prevention of gout

Dosing:

-Once daily with food and drink lots of water

-Need to dose adjust in kidney disease

Mechanism of Action:

Inhibits xanthine oxidase which is an enzyme which produces uric acid

Place in Therapy:

Recent developments seem to favour allopurinol because of wider dosing adjustments and better safety profile

Adverse Effects:

-rash (more likely with HLA-B 5801 positive allele for allopurinol)

-upset stomach (take with food)

-can be nephrotoxic (drink more water and dose adjust)

-diarrhea

-phototoxicity

-increased liver function tests

**increased risk of cardiovascular events with febuxostat

Drug Interactions:

azathioprine, mercaptopurine, theophylline --> all of these are cleared via xanthine oxidase, so they can accumulate with toxicity if used with urate-lowering therapies.