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1
Management of Acute Gout (target pain & inflammation)
NSAIDs
First-line treatment.
Any NSAIDs can be used but avoid aspirin because aspirin may cause
urate retention, unless it is given in high dose.
COX-2 inhibitors
Alternative for traditional NSAIDs, risk of peptic ulcer, traditional NSAIDs
intolerance, acute gout attack of several days duration (prolonged
course of pain-killer may be needed).
Colchicine
Alternative for those whom NSAIDs & COX-2 inhibitors are
contraindicated.
Take 2 tabs upon attack. After 2 hrs, take 1 tab again up to TDS.
Max: 6mg/day
When to stop? - when patient start to have diarrhoea.
2
Corticosteroids
Can be considered for elderly & those with renal insufficiency, hepatic
dysfunction, cardiac failure, peptic ulcer, hypersensitivity to NSAIDs or
COX-2 inhibitors.
3
Probenecid
Uricosuric drug.
Alternative to allopurinol.
MOA: Increase excretion of uric acid in urine; reduce reabsorption of
uric acid at proximal convoluted tubules.
Contraindicated in patients with uric acid overexcretion and
overproduction; urate nephropathy; urate nephrolithiasis (due to the
risk of crystal precipitation & stone formation).
Contraindicated in renal impairment, where CrCl<30.
Renal function & 24-hr urinary urate excretion must be assessed before
starting probenecid.
Side effects: GI disturbance (hence, advise patient to take after meal);
hypersensitivity rash.
Dosage: 0.5-1 g/day, may increase up to 1.5-2 g/day (in divided doses).
Examples of drug-drug interactions with probenecid:
Penicillin, salicylate – decrease tubular excretion
Furosemide – increase its serum concentration & augments its diuretic
effect.
Lifestyle Modifications
Restrict food with high purine (Appendix 1) & alcohol.
Consume low-fat dairy products.
Drink more water (2-3L) *limited water intake for renal failure patients*
Exercises.
Achieve ideal BMI (avoid overweight/obesity).
4
Management of Urate nephropathy (kidney injury due to high levels of uric acid in urine)
Extra:
Febuxostat 80 mg (Feburic®)
Xanthine oxidase inhibitor
Is a non-purine analogue (vs allopurinol: purine analogue)
Studies showed that effectiveness of febuxostat is better than allopurinol.
Dosage: 80 mg daily, may increase up to max 120 mg/day.
CrCl<30: 40 mg/day.
Cause higher CV risk than allopurinol (vs allopurinol: SJS, TEN, rash, bone
marrow suppression, anaemia)
May cause drowsiness (same like allopurinol).
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Examples of OTC/supplements for gout?
Roots Noni Enzyme extracts - flush off uric acid (1 measuring cup ON)