Gout is caused by high levels of uric acid in the blood, which can deposit as crystals in tissues and joints. Treatment involves lowering uric acid levels using drugs that inhibit uric acid synthesis or increase uric acid excretion. For acute gout attacks, medications like colchicine and NSAIDs are used. Chronic gout is treated long-term with uricosuric drugs like probenecid or allopurinol, a xanthine oxidase inhibitor that reduces uric acid production. These long-term therapies can prevent future gout attacks and kidney damage if uric acid levels are maintained below saturation point.

1. PHARMACOTHERAPY OF GOUT

2. CLASSIFICATION
In acute gout
• Colchicine
• NSAIDs
In chronic gout
• 1. Uric acid synthesis inhibitors-
• Allopurinol
• Febuxostat
• 2. Uricosuric drugs-
• Probenecid
• Sulphinpyrazone
• Benzbromarone

3. • Gout- metabolic disorder, high levels
of uric acid in blood
• Leads to deposition of uric acid
crystals in tissues, joints, kidney.
• Therapeutic strategies- lowering uric
acid levels below saturation point-
6mg/ml

4. 1. COLCHICINE
TREATMENT OF ACUTE GOUT
•Alkaloid obtained from Colchicum
•Highly effective in treatment of
acute gouty arthritis

5. MECHANISM OF ACTION

6. ADR
ALOPECIA GI
DISTURBANCES
ANEMIA
LEUCOPENIA

7. DRUG INTERACTIONS
• Cimetidine and Erythromycin reduces
metabolism of Colchicine and increases its
toxicity

8. THERAPEUTIC USES
• Orally, 2 doses of 1.2mg, foll by
.6mg hr later
• Relieves pain 24-48hrs later
Treatment of
acute attacks
of gouty
arthritis
• Prophylactically- 0.6mg twice daily
• Reduces frequency of attacks in pts
having 3 or more attacks a year
Prevention of
acute attacks
of gouty
arthritis

9. 2. INDOMETHACIN
Dose- 25-50mg tid for 5-7 days- relieves pain
Gastric intolerance-high
Alternatives- Naproxen, Sulindac, Ibuprofen

10. 3. GLUCOCORTICOIDS
• Very severe cases
• Action- not specific
• Prednisolone- 30-40mg first day, reduced by 5-
10mg every day

11. • Reduce plasma urate levels
• Do not prevent acute attacks
• Diminish incidence of renal damage
• Therapy started only after subsidence of acute
attacks as it may delay recovery
• But pre existing therapy should not be
stopped in case of acute attack
LONG TERM TREATMENT OF GOUT

12. I. URICOSURIC DRUGS
A. PROBENECID
• Orally, initial dose- 0.5g once daily, increasing
to 3 times daily
• Small dose- decrease distal tubule secretion
of uric acid
• Large dose- increase excretion, blocks
reabsorption
• ADR- Well tolerated, dyspepsia, skin rashes

13. DRUG INTERACTIONS
• Inhibits renal excretion of Penicillin,
Indomethacin, Dapsone
• Impairs heparin metabolism
• 0.5-1g OD
• BENCID 500mg tab
DOSE

14. B. SULPHINPYRAZONE
• Actions, ADR- Same as Probenecid
• Once/Twice daily
• Chronic gout- 200mg/day, increased to 400-
800mg/day
• ANTURAN 100, 200 mg tab
C. BENZBROMARONE
• Inhibits tubular reabsorption of uric acid
• 40-80mg once daily
• Comb with allopurinol

15. II. XANTHINE OXIDASE INHIBITORS
A. ALLOPURINOL
•Analogue of hypoxanthine
•Inhibits biosynthesis of uric acid
PHARMACOKINETICS
•80% absorbed orally
•T1/2- 2-3 hr

16. MECHANISM OF ACTION

17. ADR
GI irritation Nausea Headache
Hypersensitivity
reactions- Rashes

18. DRUG INTERACTIONS
• Anti cancer drugs- 6-mercaptopurine,
Azathioprine are metabolized by xanthine oxidase
• So, dose of anti cancer drugs should be reduced
when Allopurinol is used
• Initial dose- 100mg/day, increased to 300mg/day
• Tophi resorbed, renal stones prevented
• ALORIC, ALURID, CIPLORIC 100,300mg tab
USES

19. B. FEBUXOSTAT
• Reduces formation of xanthine an uric acid
• ADR- gout flares, nausea, diarrhoea
• Dose- 80-120mg

20. THANK YOU