GOUT
rename
sgthuan's
version from
2017-07-06 13:50
GOUT - uric acid < 6, ONLY treat when gout attack happens
| generic | Brand | class | drug pearl |
|---|---|---|---|
| colchicine | Colcrys | Gout - anti-inflammatory agent | initial 1.2mg, followed by 0.6mg, MAX 1.8mg per HOUR --> MAX 2.4mg per DAY, ** dose repeats > 3 days, SE severe GI upset, N/V, *** Diarrhea, **** Beer's list with CrCl < 30 --> myelosuppression, myopathy, neuropathy, CYP 3A4 substrate --> Avoid strong inhibitors Clarithromycin or cyclosporin |
| indomethacin | Indocin | NSAIDs | 50mg TID, Avoid use in severe renal disease, SE GI toxicity and psychiatric side effects |
| naproxen | Naprosyn | NSAIDs | 750mg x1 then reduce to q8h until resolved, Avoid use in severe renal disease |
| sulindac | Clinoril | NSAIDs | 200mg BID until resolved, Avoid use in severe renal disease |
| prednisone/prednisolone | NONE | steroids | 0.5mg/kg/day for 5-10 days --> no taper |
| methylprednisolone | medrol, Solu-medrol | steroids | intra-arcular or PO dose pack |
| triamcinolone | NONE | steroid | IM 60mg, then start PO prednisone |
| allopurinol | Zyloprim, Aloprim | Xanthine Oxidase Inhibitor | initial 100mg qd, slowly titrate up UNTIL urate < 6mg/dL, *** skin rash, SJS --> test for HLA-B*5801, SE rash, acute gout attack --> give NSAIDs or Colchicine for 6 months, increased LFTs, NAUSEA --> take with FOOD, **** Lower dose with renal impairment CrCL < 50 decrease 50% |
| febuxostat | Uloric | Xanthine Oxidase Inhibitor | initial 40mg qd, up to 80mg at 6 weeks, *** CI - do NOT use with didanosine, mercaptopurine, pegloticase, ** Hepatotoxicity --> increased LFTs, SE acute gout attack --> give NSAIDs or Colchicine for 6 months, expensive but NO dose adjustment for renal impairment and NO SJS |
| zurampic | Lesinurad | inhibit uric acid reabsorption | *** 200mg qAM ONLY with XOI, CI - CrCl <30, ESRD, dialysis, BBW acute renal failure --> with FOOD and hydrated, SE increased SCr (transient) |
| probenecid | Probalan | inhibit uric acid reabsorption | initial 250mg BID, CI - acute gout attack, aspirin therapy, kidney stone, blood dyscrasias, children < 2, *** do NOT use CrCl < 50, hemolytic anemia with G6DP deficiency, *** also use to increase beta lactam levels |
| pegloticase | Krystexxa | recombinant uricase enzyme | 8mg IV q2weeks --> used for severe & refractory disease, *** CI - G6DP deficiency, *** BBW anaphylactic reaction --> premedicate with antihistamine & steroids, do NOT use with allopurinol |
| rasburicase | Elitek | recombinant uricase enzyme | 0.2mg/kg IV daily, max 5 days, ONLY for tumor lysis syndromes |
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