Hypouricaemic Agents in The Treatment of Gout

Abstract

The serum uric acid is diminished pharmacologically by drugs which increase the renal excretion or inhibit the synthesis of uric acid. Probenecid and sulphin-pyrazine, the commonly used uricosuric compounds, should be given when there is normal renal function, normal daily excretion of uric acid and no history of renal calculi. Allopurinol, a xanthine oxidase inhibitor with multiple other metabolic effects, can be used in other situations. Under ordinary circumstances these drugs have proven effectiveness in the long-term management of gout. Uricosuric drugs become ineffective during renal failure. In this situation allopurinol retains its efficacy but has an increased incidence of side reactions and should be given at a lower dosage. Because hypouricaemic drugs can themselves precipitate acute gout, therapy is not ordinarily initiated during an acute attack and prophylactic anti-inflammatory therapy is usually given for a period of 6 to 12 months. Hypouricaemic therapy for gout is usually considered to be life time treatment. Therefore, the physician should be rational and thoughtful in the approach to therapy and in the choice of an appropriate drug.