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10.2 Hyperuricaemia and gout

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

10.2 Hyperuricaemia and gout

Alkaloids

 

Colchicine  (Amber1)

  • Tablets 500 micrograms       

Notes:

  • High doses of NSAIDs or colchicine may be used for the treatment of acute attacks of gout. Caution: NSAID toxicity in high risk (especially older) patients and GI toxicity with colchicine.
  • Colchicine is of value for patients with heart failure since, unlike NSAIDs, it does not induce fluid retention. It can also be given to patients receiving anticoagulants.
  • 500 micrograms every 2-4 times daily until relief of pain is obtained or vomiting or diarrhoea occurs or until a total dose of 6mg (12 tablets) has been reached. The course should not be repeated within 3 days.
    • Colchicine has a narrow therapeutic window and is extremely toxic in overdose
    • Patients at particular risk of toxicity are those with renal impairment, gastrointestinal or cardiac disease, and patients at extremes of age
    • The symptoms of overdose are often delayed    

 

Xanthine Oxidase inhibitors

 

Allopurinol

  • Tablets 100mg, 300mg       

Notes:

  • Allopurinol is indicated for gout prophylaxis but it should never be started during, or within one month of, an acute attack. Colchicine or NSAIDs should be used as a prophylactic and continued for at least one month after the hyperuricaemia has been corrected.
  • The dose of allopurinol and colchicine should be reduced in patients with renal failure.

 

Febuxostat (Amber 2)

Tablets 80mg, 120mg

Notes:

 

 

 

 

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

Return to Chapter: 10. Musculoskeletal and Joint Diseases

Last updated by: Dupe Fagbenro on 13-03-2019 09:08