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 |
| NG219 [updates and replaces NICE TA164] : 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.
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Intolerance of allopurinol isdefined as adverse effects that are sufficiently severe to warrant its discontinuation, or to prevent full
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dose escalation for optimal effectiveness as appropriate within its marketing authorisation. Annual treatment costs for
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febuxostat are approximately £318 while for allopurinol they are approximately £16. SEE FULL GUIDANCE.
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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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