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10.1.4 Gout and cytotoxic-induced hyperuricaemia

10.1.4 Gout and cytotoxic-induced hyperuricaemia

10.1.4 Gout and cytotoxic-induced hyperuricaemia 

Acute attacks of gout
High doses of NSAIDs are usually used.
Colchicine is an alternative. The BNF dose of colchicine is known to cause gastrointestinal side effects, particularly in patients with impaired
renal function. Local rheumatologists recommend colchicine be given at a dose of 500micrograms twice daily for acute gout.
 
GREEN      Colchicine tablets 500 micrograms 
 
Long term control of gout    
Long term control to reduce formation of uric acid can be achieved with allopurinol. It should not be started during an acute attack. 
For approximately the first 6 weeks of therapy NSAIDs or colchicine should also be given.
 
GREEN      Allopurinol tablets 100mg, 300mg 
 
Febuxostat  
NICE TA164 advises febuxostat, within its marketing authorisation, as an option for the management of chronic hyperuricaemia in gout only 
for people who are intolerant of  allopurinol or for whom allopurinol is contraindicated.  Intolerance of allopurinol is defined as adverse
effects that are sufficiently severe to warrant its discontinuation, or to prevent full dose escalation for optimal effectiveness as appropriate within 
its  marketing authorisation.  Annual treatment costs for febuxostat are approximately £318 while for allopurinol they are approximately £16.
 
Drug Safety Update July 2019 advises avoiding treatment with febuxostat in patients with pre-existing major cardiovascular disease (for example, 
myocardial infarction, stroke or unstable angina), unless no other therapy options are appropriate.
 
AMBER     Febuxostat tablets 40mg, 80mg 
 
Hyperuricaemia associated with cytotoxic drugs
 
RED           Rasburicase 1.5mg (Consultant Haematologist use only) 
 
 
 
 
 
 
 
 
 
 

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