Probenecid, Sulfinpyrazone and Benzbromarone excrete uric acid
This page about urosuric drugs was last reviewed, or updated, on 22 March 2011. PROBENECID (BENCID, BENECID, BENEMID, PARBENEM, PROBALAN, BENURYL, PROBECID, PRO-CID, BENEMIDE, PROBEN) 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 re-absorbing it into the blood. And they are long term gout treatments because insufficient uric acid excretion is for many people the cause of hyperuricemia. Probenecid is the second oldest still-current gout drug, (after colchicine) having been introduced as long ago as 1951. It works by encouraging the kidneys to remove uric acid from the blood and discourage returning it. Thus it works also to head off another danger of excess uric acid, which is the formation of kidney stones. These stones may also form in the ureters and the bladder. Once started, it is a long term gout treatment which doctors will want to continue. In the early stages of treatment, a risk is that urosuric drugs may increase the frequency and severity of gout attacks. But eventually (probably 6 months to 2 years) attacks cease for most sufferers. You need to 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 it can lead to the formation of MSU gout crystals and kidney stones. If a gout attack occurs and you’re already taking it, you 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. Your doctor should do a blood creatinine test to find out how well your kidneys are working before starting you on it. If they aren't working well enough it won't work, but allopurinol and febuxostat (which both lower uric acid production and don't act on the kidneys) probably will be prescribed. If you take probenecid your doctor may also consider whether you need to make your urine less acidic and more alkaline. (Higher pH). Acidic urine can be a part cause of uric acid kidney stones. Keeping the urine diluted and alkaline (higher pH) helps to prevent this. Read more about this on our Potassium Citrate page.
Probenecid may be prescribed together with Colchicine, to help prevent the next gout attack because it 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 it. It may stop it working and low dose aspirin is feared as a cause of gout. 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). Sulfinpyrazone is said to work better when the body is more alkaline (higher pH levels). As with probenecid, people with kidney disorders, or a risk for them from other causes, should not take it. Once started, sulfinpyrazone too should be continued because of the risk that gout attacks will restart. 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. Sulfinpyrazone is not available in the U.S.
Benzbromarone has been an under-excretor drug medication for about 25 tears. In some studies it has achieved excellent results - a uric acid fall of around 5.0 mg/dL. Benzbromarone is available in some countries (eg. Britain, New Zealand, Italy, Japan, China, Taiwan and Germany). But in others it was withdrawn (eg. the U.S., France, some European countries), 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. Contraindicated in patients with Porphyria, moderate and severe kidney disease, uric acid kidney stones, and people who excrete more than 700 mg of uric acid in 24 hours; also people with liver problems. Contraindicated with warfarin. Dosage 20mg - 120 mg. Possible side effects include diarrhea,(diarrhoea) kidney stones, liver problems.
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