GoutPal Interactive

Things have been quiet so I thought I'd bore you all!

A uricosuric agent is anything that will increase the excretion of uric acid via urine…cute name.

It behooves us goutiies to choose drugs that increase uric acid elimination.

I've often mention losartan (Cozaar) as one of these and written about the study done in Japan showing how losartan plus Lasix (furosemide) is an excellent treatment regimen. Note that NO OTHER antihypertensive behaves this way.

I know that as we reach a tender age, many of us are on treatment for cholesterol lowering. The agent of choice here is Lipitor (atorvastatin) because it is the only ststin drug that LOWERS uric acid by increasing excretion. A study showed atorvastatin lowered serum uric acid by 15% but simvastatin did nothing. Shame Lipitor is still under $$$ patent protection$$$$  but that expire next year and prices will plummet.

I have seen mention of  the same uricosuric effect with the FIBRATE drugs but they have gotten some bad press recently and may not be a wise choice for cholesterol control.

The expectorant in a lot of cold medications, guiafenesin, exhibits substantial uricosuric effect and has been praised in high doses by those suffereing from fibromyalgia…maybe a uric acid connection?

Aspiirin in huge dosages is extremely uricosuric although in normal dosages (under 2 grams a day) has the opposite effect.

If you come accross any other agents in the literature, please bring them to our attention here. If we need to take a drug for hypertension, high cholesterol, or fibromyalgia it might as well be one that LOWERS our uric acid rather than one that RAISES it.

Happy Anniversary and avoid the Sha Cha Sweetbreads or the Kung Pau Anchovies.

Trev,

Since I start Allopurinol tonight, I will try to document in the forum how I do over the next three months until my next doctor visit/blood uric test. Hopefully my journey will be able to help others decide if its the right thing for them as I decided it was for me.

I admit I am fortunate that I do not have BP issues (110/72 today at the doc office) to complicate matters.

Tavery said:

Since I start Allopurinol tonight, I will try to document in the forum how I do over the next three months until my next doctor visit/blood uric test. Hopefully my journey will be able to help others decide if its the right thing for them as I decided it was for me.

I admit I am fortunate that I do not have BP issues (110/72 today at the doc office) to complicate matters.

Yes Tave. it will be instructive to follow the figures as this  is the dark corridor for management of UA and the drugs for its control.

Your Gout 'Attack profile' will be interesting.

I would like to try a 'slow start' of 100mg/day , if I go down the same route. 

The costs for blood testing is high – I discussed the amount of work with a nurse recently and it is substantial. I've seen this factor mentioned in drug comparison trials as an element to consiider overall. My BP is closing with 130/80 which for me is great, after reaching 220 /120.

Zip. I take one dose 40mg first thing then allow 5 to 6 hours to clear before Losartan 50mg.[Watch pottassium intake]

I take two other drugs that clash- so need space to fit them in [not too much] later.

Rasilez 150mg (DRB) knocks Lasix back 50%-C /30%- AUC.   [+ No grapefruit/ or with high fat meal]

Atenolol can raise lipids, co- admined with Lasix, so that waits till later also. ( My Lipids are actually down).

None of the food/ drug,  drug/drug reactions or blood testing regime were stressed enough by medics. The pharmacy relies on computer flags to highlight, [the known ones].

On that, as a Gouty , I was well prepared to do my own research and use online  sites I've already posted here to help clarify these important issues.

One  recently opening factor is how fruit juices affect many drugs- grapefruit[well known] ,orange and apple[unknown culprit] all are capable of markedly affecting drug actions, up or down.

Why suffer side effects- some possibly serious - to get only 50% or less efficacy out of these expensive drugs?

On the the BP side my only random variable is keeping my pulse above 40bpm- no wonder no-one likes to look too often ;) – so being veggy and clean living does allow some fine tuning!

My bread making is improving too!

Lancet? – No Ta!, I would need to be' moved on' to get an easy mention there…   ;)

Goutpal is good enough for me :)

Rasilez effective? Not sure tbh.

When I first started it  (never on its' own) I was convinced it gave me loose stomach for quite some days.The doc (who actually hadn't started this one) suggested cutting tea down ,so I did and my tum settled ?? Not sure if it was co- incidence, but i've kept tea to 2 cups a day since.

I chopped  Rasilez  from 150mg/day- down to 'every other day' a few weeks back, as I was getting woozy on so many factored drugs. Since then my BP has dropped some -so I would have to say it could only be partly responsible for success.

Pretty certain ,as expected that Lasix (diuretic) is the main cause of recent BP reduction.

I have to also state that I take very low dose (due to its' potency for me) of Clonidine.

I don't like it ,as it a knock out drug (for me) at  levels used to affect BP.

People have had heart attacks stopping it in the wrong way, especially taken with BetaBlock as I do. [Not together]

You can see now why I'm wary of meds!

The point is, on this last, [Clon] is that it counteracts the DRB effects -as it's a  slower of stomach action too- that's why I keep a small dose going- though I want to stop it  to see the effect , if poss.

It seems to stop transients btw.

I've seen reports that ARB (Cozaar) is effective at basic dose used with DRB so I would not look to stop that unless other reasons come in to play.

Good point about taking Lasix with that AlloP- I will try this also if treatment pans out that way.

Always bear in mind Rasilez has a 40 hour clearance -so doesn't lend itself to fiddling with timing very well. Just don't take it near Lasix if you get on Rasilez [6 hrs later maybe?] and then better on the every other day plan to give Lasix a chance! They aren't really compatible in my book for optimum use ,but who's to say what really goes on with these combos? Mine is a good enough compromise, I think.

Certainly not any really odd side effects for me after settling down on them.

At my hospital appt. last month, one of the 3 Docs I saw over a period -and one which I had a good dialogue with, said Atenolol was a bit 'old hat' these days. That just made me add it to the list of ones to drop asap, but not out of spite, as well I might….

The reason I don't like the class of drug is its tendency ( nay, speciality)  to lower libido, and at my [our] age you don't want THAT, as Meatloaf cleverly puts it!

[Never sure what he was actually singing of]

I hope finally, to settle on 3 BP drugs- and at minimum adjusted doses with food clashes minimalised to optimiise take up.

If AlloP gets added, fair enough, but at 100 mg start and maybe one more try at the diet control first. My BP and Lipids are down ,only my SUA faces the wrong direction currently.

I'm hopeful that Allop has an inate BP lowering function as shown in that recent US trial on teenagers, where this outcome  was demonstrated.

Every little bit helps!

The Doc (of many on rota now) I saw today is one who knows gout well having been on his back in agony 2 years with gout in the spine.

Two other Docs mis-diagnosed him-  take heart, or not, depending on view!

He told me before , that he'd been suicidal and I knew what he meant.

Today he mentioned that the trigger was losing 5 stone in weight on a starvation diet- and I have just lost a stone- so shouldn't have been surprised at an attack whilst re-starting a diuretic [albeit, a kinder one for gout, Lasix]. Crash diets and Gout don't mix, we know.

The final point here , is that this guy is on 200mg of AlloP, and is now back working because of it- so, even for a severe case, mega dosing isn't always necessary , it seems.

I've got some 100mg to use if needed to start  in a quiet patch -if that's where I go with it.

I agree with all three points.

The Doc in ? swears by Allopurinol as a saviour, in his case. Not sure what specific he took for the pain-I will ask him tm.

He hasn't pushed [AlloP] it on me to be fair- but is mainly warning me against future joint damage left untreated if not managed better.

I was surprised m given the history ,that 200 mg was enough in his case- but on reflection after posting this earlier, I realised that it could have been higher interim. I will try and get that info too.

All the same, it's helpful to know that moderate doses can work in severe cases- if the wind and tide are in the right direction [sorry, old sailor ahbit- and can't resist some salt on the shoulders!]

Post edited 5:02 pm – July 31, 2009 by zip2play

I take 650 mg. aspirin EVERY night to make sure I have my platelet stickiness issue covered. Overkill, YES. Anti-uricosuric, YES.

But if one of my OTHER coronary arteries closes off (I have a stent holding my RCA open), my uric acid level won't be too much of a problem. I don't trust the kiddie aspirin silliness.

I have tried dosing with 16 aspirin a day as a POTENT uricosuric…it's inhuman! But NOTHING beats it as a uricosuric short term.

(Paracetamol is a liver killer…it should be banned! Ibuprofen is a wonderful pain killer but SO many people get gastritis from them. I wish I could take Ibu more often. Naproxyn works well but causes me weight gain…I found out that I am not alone in this, but I judge it to be the best pain killer available over the counter…although I think the EU and UK might still demand an Rx.)

I have a quest, courtesy of zip2play, to find out if naproxen has uricosuric effects. I've drawn a blank on that so far, but found other pain relief that I'd not heard of before:

Tenidap. From “Tenidap: not just another NSAID?”

a decrease in serum uric acid, phosphate, calcium, and bicarbonate relative to baseline concentrations, though maintained within the normal range, also occurs, indicating that tubular function is affected.

The report does not give uric acid details. It is based on rheumatoid arthritis patients, so the uric acid angle isn't considered beyond the quote above.

Diflunisal (Dolobid). A derivative of salicylic acid, which is chemically different from aspirin. FDA lists Dolobid (a Merck brand) as discontinued but not for safety or efficacy reasons. It is available under prescription as a 500mg tablet from Teva. Approval tests for Dolobid show uricosuric effects however these tests were on osteoarthritis or rheumatoid arthritis patients.

In “Hypouricemic action of diflunisal in gouty patients”, the gout sufferers were split into normal uric acid excreters and overexcreters (more than 3.86 mmol in 24 hours). Diflunisal had no effect on overexcretors, but normal excreters increased uric acid excretion and lowered blood uric acid at 500mg and 1000mg doses.

That last one opened up a massive source of new uricosuric opportunities. If you direct your attention to the new search box at the foot of the page (where it says “Say Hello to Search 2.0″), and type in Hypouricemic action gout it opens up a whole new world of uric acid reducing opportunities.