Probenecid, Sulfinpyrazone and Benzbromarone excrete uric acidPROBENECID (BENEMID, PARBENEM, PROBALAN, BENURYL) Long term gout treatment Probenecid, sulfinpyrazone and benzbromarone are classed as urosuric drugs (sometimes called uricosuric). They encourage the body to excrete uric acid in the urine by preventing the kidneys from absorbing it. They are long term gout treatments because insufficient uric acid excretion is for many people the cause of hyperuricemia. In the early stages of treatment, a risk is that urosuric drugs may increase the frequency and severity of gout attacks. But eventually attacks usually cease or are reduced. Drink lots of water on a course of probenecid, perhaps supplemented with an alkalizing agent, if your doctor agrees. Drinking water is always essential in both drug medication and natural remedy gout treatment, and is worth repeating again because probenecid can lead to the formation of MSU gout crystals and kidney stones. If a gout attack occurs and you’re already taking it, continue to do so. But don’t start taking it during a gout attack. It cannot be taken by gout patients with kidney stones or kidney disease or a with a risk of developing kidney disease from other causes. It may work better when the urine is more alkaline (higher pH). Probenecid may be prescribed together with colchicine to help prevent the next gout attack because probenecid can initiate a gout attack. Dosage: 250-500mg twice daily. Lower initially. Dosage may be less if your drink plenty of water. Low dose aspirin should probably not be taken with probenecid. It may stop it working. Discuss this point with your doctor. If there's no recurrent gout attack in six months the dosage will probably be reduced. Keep checking for lowered uric acid levels. Possible side effects: It is usually well tolerated, but side effects include – headaches, nausea, vomiting, skin rashes, gout crystal kidney stones, bone marrow depression, and appetite loss. It may reduce the excretion of other drugs from the body. SULFINPYRAZONE (ANTURANE, ANTURAN) Long term gout treatment Sulfinpyrazone, like probenecid, works as a gout treatment by removing uric acid. It may be used instead of probenecid because its side effects are different and it is thought to be stronger and sometimes more effective than probenecid. The other usual caveat of these long term gout medications applies – if a gout attack occurs and you’re already taking it, continue to do so. But don’t start taking sulfinpyrazone during a gout attack. Drink lots of water to help avoid the creation of MSU gout crystals as kidney stones – remember that sudden changes of uric acid levels are a gout trigger.
(See the What to drink? page for why).
Dosage: Tablets or capsules.50 - 200mg initially twice daily, gradually up to up to 200 – 400mg twice daily. May be less if you drink lots of water. Low dose aspirin should probably not be taken with sulfinpyrazone. It may stop it working. Discuss this point with your doctor. Possible side effects include: breathing difficulties; sore throat; swollen glands; bleeding and bruising; fevers; bone marrow disorder; ulcers.
Benzbromarone has been an under-excretor drug medication for about 25 tears. In some studies it has achieved very good results - a uric acid fall of around - 5.0 mg/dL. Benzbromarone is available in some countries (eg. Britain, New Zealand and Germany)but not in others, (eg. the U.S.),mainly because of concerns that it can harm the liver. Ask your doctor whether it's available in your country. As with other urosuric drugs a risk is that it may increase the frequency and severity of gout attacks. Dosage: 20mg - 120 mg. Possible side effects include: diarrhea, kidney stones, liver problems.
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