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Drugs For Gout


  • Gout is a metabolic disease characterized by recurrent episodes of acute arthritis due to deposits of Monosodium Urate in joints and cartilage. Gout is usually associated with a high serum uric acid level (hyperuricemia), a poorly soluble substance that is the major end product of purine metabolism.
  • While clinical gouty episodes are associated with hyperuricemia, most individuals with hyperuricemia may never develop a clinical event from urate crystal deposition.
  • Urate crystals are initially phagocytosed by synoviocytes, which then release prostaglandins, lysosomal enzymes, and interleukin-1. Attracted by these chemotactic mediators, polymorphonuclear leukocytes migrate into the joint space and amplify the ongoing inflammatory process. In the later phases of the attack, increased numbers of mononuclear phagocytes (macrophages) appear, ingest the urate crystals, and release more inflammatory mediators.
  • This sequence of events suggests that the most effective agents for the management of acute urate crystal-induced inflammation are those that suppress different phases of leukocyte activation.

Drugs For Gout

  1. Colchicine                                                    
  2. NSAID’s
  3. Uricosuric Agents (Probenecid, Sulfinpyrazone)
  4. Allopurinol, Febuxostat, Pegloticase (Uric Acid Inhibitors)
  5. Corticosteroids                                        
  6. IL-1 Antagonist (Anakinra, Canakinumab, and Rilonacept)- Under Trials


  1. Colchicine
    1. Oldest anti-gout drug                                             
    2. Most effective                                    
    3. Most toxic
    4. Plant derived alkaloid (cochicine)                       
    5. Anti-chemotactic                              
    6. Prevent microtubule polymerization                   
    7. Causes metaphase arrest  



  1. Well absorbed                                         
  2. Eliminated by bile 
  3.  Recurrent/refractory gout                   
  4. Acute Mediterranean fever


Side effects

  1. Diarrhea                   
  2. Neuropathy                                     
  3. Myopathy                         
  4. Alopecia                   
  5. Bone marrow depression  
  1. Oxaprozin
    1. NSAID’s                     
    2. Given in acute gout                        
    3. Not used in uric acid stones (because it is uricosuric)
  2. Probenacid/sulfinpyrazone
    1. Uricosuric
    2. Use
      1. Tophi                  
      2. Frequent gout attacks             
      3. Gout refractory to allopurinol/fabuxtat
  3. Allopurinol
    (AIIMS May 09)
    1. Xanthine oxidase inhibitor                    
    2. Well absorbed                
    3. Long acting                                                               
    4. Eliminated by bile



  1. Chronic gout                                            
  2. Leish-Nehan syndrome
  3. Gout with renal failure                           
  4. Gout with tophi
  5. Urate nephropathy                               
  6. Tumor induced hyperuricemia


Side effects

  1. GI upset                                                    
  2. Granulomatous hepatitis
  3. Neuropathy                                              
  4. Bone marrow depression
  5. Cataract                                                  
  6. Precipitates attack of acute gout



  • Reduce dose of azathioprine                                         
  • Inhibits metabolism of:

Cyclophosphamide            Oral anticoagulants           Probenacid (COP)


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