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Newer drugs for treatment of Gout


  1. Febuxostat
    1. Non-purine xanthine oxidase inhibitor
    2. Well absorbed; high first pass
    3. Safer than allopurinol
  2. Pegloticase
    Treatment of refractory chronic gout.
    Pegloticase is a recombinant mammalian uricase that is covalently attached to methoxy polyethylene glycol (mPEG)
    Urate oxidase enzyme, absent in humans and some higher primates, converts uric acid to allantoin which is exreated by kidney 
  3. Benzbromarone
    1. It is a uricosuric  
  4. Rasburicase
    It converts purine into allantois which is a water soluble compound and goes out of the body by urin.  
  5. Losartan, amlodipine and Fenofibrate have uricosuric action.

Golden Points

  1. Aspirin is most commonly used NSAID, it has analgesic, antipyretic, antiinflammatory, anti-platelet and uricosuric actions
  2. Aspirin is contraindicated in ulcer patients, bleeding disorders, patients with nasal polyp, asthma and children with viral fever (Due to fear of Reye’s syndromemetabolic encephalopathy)
  3. Aspirin is longest acting anti-platelet drug acting for more than 72 hours; its antiplatelet in low doses
  4. In aspirin poisoning; metabolic acidosis is seen in children while metabolic alkalosis is seen in adults
  5. Vitamin K & fresh frozen plasma are used in aspirin poisoning
  6. Ibuprofen is safest oldest NSAID causes toxic amblyopia
  7. Indomethacin is most toxic NSAID; MC side effect is frontal headache (50% cases); it is DOC for ankylosing spondylitits, acute gout, post-coital headache, Barter’s syndrome & closure of PDA-it is contraindicated in drivers, machinery operators, hematological, neurological and psychiatrically ill patients
  8. COX-2 inhibitors (Celecoxib, rofecoxib, valdycoxib, parecoxib etc) are safer newer NSAID with less likelihood of symptomatic GI side effects such dyspepsia, ulcer, heartburn etc
  9. Ziconotide is approved for intrathecal analgesia. It blocks N type voltage gated Na+ channels
  10. Tapentadol is mu agonist and NA reuptake inhibitor, used as analgesic.
  11. H. Pylori is MC cause of peptic ulcers; NSAIDs are 2nd MC cause-NSAID induced ulcers are H. Pylori negative
  12. PGE2 is a bronchodilator prostaglandin; others are bronchoconstrictors.
  13. PGE1 (Misoprostol) used in ulcer prevention and maintenance of patency of ductus arterious but causes diarrhoea as MC side effect
  14. PGF2 alpha is a vasoconstrictor of pulmonary vessels, and is also used in post-partal hemorrhage and 2nd trimester abortions
  15. Probenacid and Sulfinpyrazone are uricosuric drugs
  16. Allopurinol (Xanthine oxidase inhibitor) is used in chronic gout, hyper-uriacemia due to anticancer drugs, and those with gout and renal failure
  17. Methotrexate is MC used DMARD; bone marrow suppression & hepatic fibrosis are MC side effects; it is DHFR inhibitor, anti-folate
  18. Cyclosporine, an immunosuppressive drug is used as DMARD, causes hepato, nephrotoxicity but does not suppress bone marrow

Newer Drugs


Varenacline ( Nicotinic receptor agonist)

Smoking cessation

Acamprosate (NMDA antagonist)

Maintenance of abstinence form alcohol

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