Managing Gout: Should I Switch from Zyloprim to Uric Acid Medications?

Q: Managing Gout: Should I Switch from Zyloprim to Uric Acid Medications?

Hello, sir： <br>1. <br>Effective uricosuric agents for treating gout may primarily work by inhibiting the reabsorption of urate in the proximal renal tubules, thereby lowering serum uric acid levels. <br>Caution is advised in patients with liver dysfunction, and these agents shou

Gout - Fubito - "You Sheng" for treating gout pain (Ben Bu Ma Long)

I previously had gout and after seeing Doctor A, I received a prescription for Febuxostat, which I took for a long time and eventually got tired of, so I stopped taking it on my own.
Now, my gout has flared up again, and after seeing Doctor B, I was prescribed Allopurinol, which I have also been taking for a long time.
After researching, I found that Febuxostat is a newer and better medication.
Should I ask Doctor B to prescribe Febuxostat, or should I continue taking Allopurinol? How can I address the root cause of my condition? Doctor A mentioned that Febuxostat can dissolve gout crystals.
Does Allopurinol have the same effect? My uric acid levels have been (12.8) ~ (5.8) ~ (5.3) ~ (5.8) with checks every three months.

Niming, 30~39 year old female. Ask Date: 2019/08/16

Dr. Hou Fangmin reply Pharmacology

Hello, sir:
1.
Effective uricosuric agents for treating gout may primarily work by inhibiting the reabsorption of urate in the proximal renal tubules, thereby lowering serum uric acid levels.
Caution is advised in patients with liver dysfunction, and these agents should not be initiated during an acute gout attack.
For patients with renal impairment, a dosage adjustment is recommended.
2.
Febuxostat is a xanthine oxidase inhibitor that can lower serum uric acid levels to achieve therapeutic effects.
There is no need to consider food or antacid interactions when taking febuxostat.
It is indicated for chronic gout patients with hyperuricemia who meet at least one of the following criteria: 1.
Previous urate-lowering medications have been ineffective, and uric acid levels remain above 6.0 mg/dL; 2.
Patients with chronic kidney disease may qualify for insurance coverage.
3.
The cost of a gout medication is approximately NT$2.26 per tablet, while febuxostat costs around NT$21 per tablet.
I see that your uric acid levels (12.8)~(5.8)~(5.3)~(5.8) have been gradually decreasing, so it is important to continue your medication.
Febuxostat should only be prescribed when your renal function is adequate, as it must meet insurance coverage criteria.
The effects of both medications are as described above, and please consult your physician to consider your uric acid levels for prescribing.
Is this response clear to you? Wishing you peace and good health.

Reply Date: 2019/08/16

More Info

Managing gout effectively requires a comprehensive understanding of the medications available and their respective roles in uric acid management. In your case, you are considering switching from one medication to another, specifically from "治風痛" (which I assume is a generic name for a gout medication) to "福避痛" (which is likely a brand name for allopurinol, commonly used to lower uric acid levels).

First, let's clarify the medications. Allopurinol (福避痛) is a xanthine oxidase inhibitor that reduces uric acid production in the body. It is often prescribed for chronic gout management and is effective in preventing gout attacks and dissolving urate crystals, which can lead to tophi (gout stones). On the other hand, "治風痛" might refer to a different class of medication, possibly a non-steroidal anti-inflammatory drug (NSAID) or another uric acid-lowering agent, but without a specific name, it's hard to provide detailed information.

Given your history of elevated uric acid levels (12.8 mg/dL) and the subsequent drops to 5.8 mg/dL and 5.3 mg/dL, it appears that you have been under some form of treatment that has been somewhat effective. However, the fact that you experienced a gout flare after stopping your medication suggests that your uric acid levels may have risen again, leading to the recurrence of symptoms.

When considering whether to switch medications, here are some important factors to consider:
1. Efficacy: Allopurinol is well-established for long-term management of gout and is particularly effective in lowering uric acid levels and preventing attacks. If your previous experience with it was positive, it may be worth discussing with your doctor.

2. Side Effects: Each medication can have different side effects. If you experienced adverse effects with allopurinol in the past, it may be necessary to consider alternatives or adjust the dosage.

3. Long-term Management: Gout is a chronic condition that often requires lifelong management. The goal is to maintain uric acid levels below 6 mg/dL to prevent flares and complications. Regular monitoring of uric acid levels is crucial.

4. Lifestyle Modifications: Alongside medication, dietary changes can significantly impact uric acid levels. Reducing intake of purine-rich foods (like red meat, shellfish, and certain fish), avoiding alcohol, and staying well-hydrated can help manage gout.

5. Consultation with Your Doctor: It’s essential to have an open dialogue with your healthcare provider. Discuss your concerns about switching medications and ask about the potential benefits and risks associated with each option. Your doctor can provide personalized advice based on your medical history and current health status.

In summary, if you are considering switching from "治風痛" to "福避痛," it is advisable to consult with your doctor about your previous experiences with both medications. They can help determine the most appropriate treatment plan based on your current uric acid levels, frequency of gout attacks, and any side effects you may have experienced. Remember, managing gout is not just about medication; it also involves lifestyle changes and regular monitoring to achieve the best outcomes.

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