5. ACUTE GOUT CHRONIC
GOUT
CAUSES
Excessive Alcohol
consumption
Diet rich in purines
Kidney disease
TREATMENT
NSAIDs
Indomethacin
Intraarticular
administration of
glucocorticoids
CAUSES
Genetic defect
Renal deficiency
Excessive production of uric
acid as in chemotherapy
Lesch-Nyhan Syndrome
TREATMENT
Depending upon the cause
Uricosuric agent , in
patients having renal
deficiency
Allopurinol is preferred in
those having excessive uric
acid production
6.
7.
8. Adverse Effects
• Treatment cause
Nausea, vomiting, abdominal pain &
diarrhea
• Chronic Administration
Myopathy, Neutrpenia, aplastic
anemia& Alopecia.
• Use with caution :
Hepatic, renal & CVS diseases
• Dose Adjustment
• in Patient taking CYP3A4 inhibitors
(itraconazole, ketoconzole)
• C/I
• in pregnancy
9. ALLOPURINOL
• It is purine analog
•Mode of Action :
• Inhibit xanthine oxidase
• Reduce production of Uric Acid
• Xanthine and Hypoxanthine are more
water soluble and less toxic
Therapeutic Uses :
• Gout
• Hyperuremia in Cancer chemotherapy
• Can be used in patients having
creatinine clearance less than 50ml/min
10. Pharmacokinetics :
• Absorption: Completely absorbed after
oral administration
• Primary metabolite : Alloxanthine
(active)
• ½ life :
• Alloxanthine/oxypurinol has ½ life 15-18
hours
• Allopurinol 2 hours
• Once daily
• Excretion : in feces and urine
Adverse reactions :
• Hypersensitivity , GIT disturbances,
Alopecia, Aplastic Anemia
11. FEBUXOSTAT
• It is new xanthine oxidase inhibitor
• It is structurally unrelated to allopurinol
• But its Mode of action, indications, adverse
effects & drug interactions are same as that
of Allopurinol.
12. URICOSURIC AGENTS
Probenecid & Sulfinpyrazone
MOD
Weak organic
acids, inhibit
urate anion
exchanger
So decrease
urate
reabsorption
ADs
Gastric distress
Should be avoided in Patient
cretinine clearance less than
50ml/min
Also inhibit excretion of
naproxen, ketoprofen,
indomethacin
Sulfinpyrazone is C/I in bone
marrow suppression
