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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 
 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
 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)