How do uricosuric agents work

A large fluid intake, alkalinization of the urine, and an initial low dosage of the drug helps prevent urate deposition in the urinary tract. Coronavirus Resource Center. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Twitter Facebook. This Issue. July 9, Seegmiller, M. Grayzel, M. Author Affiliations Bethesda, Md. Access through your institution. Add or change institution.

Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. Free access to newly published articles. Chronic gout is a type of inflammatory arthritis caused by high levels of uric acid in the blood leading to crystal formation in the joints and repeated attacks of acute gout. Treatment of chronic gout can make acute gout attacks less likely. Uricosuric medications work to lower blood uric acid levels by increasing the amount of uric acid that is eliminated via the kidneys.

This summary of a Cochrane review presents what we know from research about the effect of uricosuric medications for treating chronic gout.

After searching for all relevant studies to May , we found five studies. Two trials compared benzbromarone with allopurinol, two trials compared benzbromarone with probenecid and one trial compared allopurinol with probenecid. We found no studies comparing uricosuric medications with placebo, or with newer urate-lowering therapies such as febuxostat or pegloticase.

We restricted reporting of results here to benzbromarone versus allopurinol, as allopurinol is a commonly used first-line treatment for gout. Key results - what happens to people with chronic gout who take uricosuric medications. Low-quality evidence indicated that there was no important difference in acute gout attacks, or in the number of people who had to stop the medication due to a side effect between benzbromarone and allopurinol.

Moderate-quality evidence from two studies showed that both medications reduced uric acid levels to a similar degree. Benzbromarone was no more likely than probenecid to result in acute gout attacks, but may result in fewer withdrawals due to side effects low-quality evidence , and is probably more likely to reduce uric acid levels to a normal level moderate-quality evidence. The trials did not measure pain, function and tophus regression. Low-quality evidence from a single study indicated that probenecid was no more likely to result in acute gout attacks than allopurinol.

Further research is highly likely to impact on this estimate. This study did not measure proportion of people achieving a normal serum urate level, pain reduction, function, tophus regression or the number of people stopping the medication due to side effects.

Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimates. We found no studies that looked at sulphinpyrazone in treating chronic gout.

We do not have information about the effects of uricosuric medications in particular groups of patients such as people with impaired kidney function or with different levels of uric acid. Possible side effects of uricosuric medications may include rash, stomach upset, flushing, dizziness, headache or acute gout attacks. Rare complications may include liver failure, kidney stones, anaemia or allergic reaction. There was moderate-quality evidence that there is probably no important difference between benzbromarone and allopurinol at achieving serum urate normalisation, but that benzbromarone is probably more successful than probenecid at achieving serum urate normalisation in people with gout.

There is some uncertainty around the effect estimates, based on low-quality evidence from only one or two trials, on the number of acute gout attacks, the number of withdrawals due to adverse events or the total number of participants experiencing adverse events when comparing benzbromarone with allopurinol. However, when compared with probenecid, benzbromarone resulted in fewer withdrawals due to adverse events and fewer participants experiencing adverse events.

Low-quality evidence from one small study indicated uncertain effects in the incidence of acute gout attacks when comparing probenecid with allopurinol therapy.

We downgraded the evidence because of a possible risk of performance and other biases and imprecision. Uricosuric agents have long been used in the treatment of gout but there is little evidence regarding their benefit and safety in this condition.

WE considered black box warnings and searched drug safety databases to identify and describe rare adverse events.