Drugs Used To Treat Gout

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a. Colchicine. While the exact mechanism of action of colchicine is unknown, the administration of the drug causes a decrease in the amount of urate crystals deposited in the various parts of the body--the result is a decrease in the inflammatory process. This drug is the oldest and most effective agent used in the treatment of acute attacks of gout. The usual dose of an acute gout attack is 1.2 milligrams immediately, then 0.6 milligram every 30 minutes to one hour until nausea and vomiting or diarrhea starts or pain is relieved. Each patient must initially titrate his own dosage. If seven tablets caused adverse effects the first administration, the patient should reduce the dosage to six tablets on the next acute attack. The usual side effect associated with the administration of colchicine is gastrointestinal irritation. Occasionally antidiarreheals are prescribed to offset this adverse effect. The patient should be informed to allow an interval of at least three days between treatments-otherwise, toxic effects may occur from accumulation.

b. Sulfinpyrazone (Anturane®). Sulfinpyrazone potentiates the urinary excretion of uric acid. This anti-gout agent has the primary side effect of gastrointestinal upset. The patient taking this medication should be told to take this medication with food or milk. This medication should not be taken with salicylates.

c. Allopurinol (Zyloprim®). Allopurinol acts by decreasing the production of uric acid. This drug is not effective in the treatment of acute gout attacks, because it has no anti-inflammatory action. In fact, allopurinol may actually intensify the inflammation seen during an acute gout attack. Although the drug cannot be used to treat acute gout attacks, the patient should be instructed to continue taking allopurinol if he has such an attack. Allopurinol may produce such side effects as skin rash and gastrointestinal upset. If the drug causes too much gastrointestinal upset, the patient can take it after meals. The patient taking allopurinol should be instructed to drink at least 10 to 12 full glasses (8 fluid ounces per glass) of fluids each day--unless informed otherwise by his physician. This is done to prevent the formation of kidney stones while taking the drug.

d. Probenecid (Benemid®). Probenecid increases the urinary excretion of uric acid. This anti-gout agent has the following side effects associated with its use: bloody urine, lower back pain, and painful urination. The patient should be instructed not to drink too much alcohol while taking this drug since doing so could lessen the therapeutic effect of probenecid. Furthermore, the patient should be told not to take aspirin with this agent because salicylates antagonize the uricosuric action of probenecid.

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