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GOUT

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sgthuan's version from 2017-07-06 13:50

GOUT - uric acid < 6, ONLY treat when gout attack happens

genericBrandclassdrug pearl
colchicineColcrysGout - anti-inflammatory agentinitial 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
indomethacinIndocinNSAIDs50mg TID, Avoid use in severe renal disease, SE GI toxicity and psychiatric side effects
naproxenNaprosynNSAIDs750mg x1 then reduce to q8h until resolved, Avoid use in severe renal disease
sulindacClinorilNSAIDs200mg BID until resolved, Avoid use in severe renal disease
prednisone/prednisoloneNONEsteroids0.5mg/kg/day for 5-10 days --> no taper
methylprednisolonemedrol, Solu-medrolsteroidsintra-arcular or PO dose pack
triamcinoloneNONEsteroidIM 60mg, then start PO prednisone
allopurinolZyloprim, AloprimXanthine Oxidase Inhibitorinitial 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%
febuxostatUloricXanthine Oxidase Inhibitorinitial 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
zurampicLesinuradinhibit 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)
probenecidProbalaninhibit uric acid reabsorptioninitial 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
pegloticaseKrystexxarecombinant uricase enzyme8mg IV q2weeks --> used for severe & refractory disease, *** CI - G6DP deficiency, *** BBW anaphylactic reaction --> premedicate with antihistamine & steroids, do NOT use with allopurinol
rasburicaseElitekrecombinant uricase enzyme0.2mg/kg IV daily, max 5 days, ONLY for tumor lysis syndromes
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