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Uricosuric

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Uricosuric, Sulfapyrazine

  • See Also
  1. Gouty Arthritis
  2. Probenecid
  3. Lesinurad
  • Indications
  1. Gouty Arthritis
    1. Uric Acid under-excreter (Urine Uric Acid < 700 mg/24h)
  • Contraindications
  1. Age >60 years
  2. Decreased Renal Function (esp. GFR <30 ml/min)
  3. Nephrolithiasis
  4. Over-production of Uric Acid
  • Mechanism
  1. Uricosurics act at the renal tubule to decrease renal reabsorption and increase excretion of Uric Acid
  • Medications
  1. Use concurrent NSAID or Colchicine when starting
  2. Probenecid (Consider Allopurinol instead)
    1. Dose: 250 mg orally twice daily
    2. Maximum: 1500 mg orally twice daily
  3. Sulfapyrazine (Rarely used)
    1. Dose: 50 mg orally twice daily
    2. Maximum: 100 mg orally twice daily
  4. Lesinurad (Zurampic)
    1. Dose: 200 mg orally each morning
    2. Risk of Acute Renal Failure (should not be used as Uric Acid monotherapy)
    3. Must be taken with Xanthine Oxidase Inhibitor (Allopurinol or Febuxostat)
      1. Allopurinol dose must be at least 300 mg/day (at least 200 if CrCl <60 ml/min)
    4. Available as Duzallo (Allopurinol with Lesinurad)
      1. As of 2017, costs $12/day (compared with $3/day for Allopurinol and probenacid)
    5. (2017) Presc Lett 24(11): 64