10.1.4 Gout and cytotoxic-induced hyperuricaemia
10.1.4 Gout and cytotoxic-induced hyperuricaemia
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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 |
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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 |
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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. |
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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. |
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AMBER Febuxostat tablets 40mg, 80mg |
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Hyperuricaemia associated with cytotoxic drugs |
RED Rasburicase 1.5mg (Consultant Haematologist use only) |
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