請問一下...
有一個患者半年內痛風發作>2次...
已經給過3個月的降尿酸藥物...(Uricon 100mg 1# qd)
1月初停藥...(慢簽到期)
結果1月底又痛風發作...
抽血結果 Uric acid>7.0
請問我是在開之前同劑量的降尿酸藥物...
還是給予低劑量的藥物呢?? (50mg 1# QD)
98/9/28 Cr=1.1, Uric Acid=14.8↑
99/1/01 Cr=1.1, Uric Acid=5.5
99/1/30 Cr=1.1, Uric Acid=12.1↑
請問可以開低劑量的降尿酸藥物給反覆高尿酸血症+痛風發作的患者嗎??
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金城武
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Cate
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Re: 請問可以開低劑量的降尿酸藥物給反覆高尿酸血症+痛風發作的患者嗎??
data存疑MK 寫:
98/9/28 Cr=1.1, Uric Acid=14.8↑
99/1/01 Cr=1.1, Uric Acid=5.5
99/1/30 Cr=1.1, Uric Acid=12.1↑
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Weily
- V1
- 文章: 1923
- 註冊時間: 週一 10月 16, 2006 9:49 pm
- 來自: 台北市，台灣
Re: 請問可以開低劑量的降尿酸藥物給反覆高尿酸血症+痛風發作的患者嗎??
劑量增加，因為gout的UA goal是 < 5.0。MK 寫:請問一下...
有一個患者半年內痛風發作>2次...
已經給過3個月的降尿酸藥物...(Uricon 100mg 1# qd)
1月初停藥...(慢簽到期)
結果1月底又痛風發作...
抽血結果 Uric acid>7.0
請問我是在開之前同劑量的降尿酸藥物...
還是給予低劑量的藥物呢?? (50mg 1# QD)
98/9/28 Cr=1.1, Uric Acid=14.8↑
99/1/01 Cr=1.1, Uric Acid=5.5
99/1/30 Cr=1.1, Uric Acid=12.1↑
如果腎功能異常或有痛風石、尿路結石，則使用Allopurinol。
前健康天地電子報主編鄭維理(Weily Jen)
專業：內科，家醫科，醫學資訊
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專業：內科，家醫科，醫學資訊
專長+樂趣：尋找/整理/分享資訊，解決問題，家庭醫業
歡迎加入醫聲論壇BAND平台，並邀請其他醫師加入，謝謝。
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Re: 請問可以開低劑量的降尿酸藥物給反覆高尿酸血症+痛風發作的患者嗎??
Effect on serum uric acid levels of drugs prescribed for indications other than treating hyperuricaemia.
http://www.ncbi.nlm.nih.gov/pubmed/1637 ... dinalpos=8
Daskalopoulou SS, Tzovaras V, Mikhailidis DP, Elisaf M.
Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, Royal Free and University College Medical School (University of London), London, UK.
Beyond allopurinol and the well-established uricosuric drugs, several other agents can decrease serum uric acid (SUA) levels, such as losartan, fenofibrate and some non-steroidal anti-inflammatory drugs (NSAIDs). Some of these drugs increase renal urate excretion. Hyperuricaemia and gout are common problems (at least 1% of Western men are affected by gout). Raised SUA levels increase the incidence of acute gout and renal calculi. Hyperuricaemia may also predict an increased risk of vascular events. Therefore, lowering SUA levels is of clinical relevance. In this review we consider the effect on SUA levels of drugs that are prescribed for indications other than treating hyperuricaemia. These drugs may obviate the need for specific treatment (e.g. allopurinol) aimed at lowering SUA levels. Furthermore, because hyperuricaemic patients may already be on several drugs (e.g. due to associated dyslipidaemia, hypertension and/or arthritis) compliance may be improved by avoiding additional medication. The potential for adverse effects associated with polypharmacy would also be decreased.
http://www.ncbi.nlm.nih.gov/pubmed/1637 ... dinalpos=8
Daskalopoulou SS, Tzovaras V, Mikhailidis DP, Elisaf M.
Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, Royal Free and University College Medical School (University of London), London, UK.
Beyond allopurinol and the well-established uricosuric drugs, several other agents can decrease serum uric acid (SUA) levels, such as losartan, fenofibrate and some non-steroidal anti-inflammatory drugs (NSAIDs). Some of these drugs increase renal urate excretion. Hyperuricaemia and gout are common problems (at least 1% of Western men are affected by gout). Raised SUA levels increase the incidence of acute gout and renal calculi. Hyperuricaemia may also predict an increased risk of vascular events. Therefore, lowering SUA levels is of clinical relevance. In this review we consider the effect on SUA levels of drugs that are prescribed for indications other than treating hyperuricaemia. These drugs may obviate the need for specific treatment (e.g. allopurinol) aimed at lowering SUA levels. Furthermore, because hyperuricaemic patients may already be on several drugs (e.g. due to associated dyslipidaemia, hypertension and/or arthritis) compliance may be improved by avoiding additional medication. The potential for adverse effects associated with polypharmacy would also be decreased.
Re: 請問可以開低劑量的降尿酸藥物給反覆高尿酸血症+痛風發作的患者嗎??
Other antihyperuricemic agents
http://www.ncbi.nlm.nih.gov/pubmed/1840 ... dinalpos=3
[Article in Japanese]
Ogino K, Igawa O, Hisatome I.
Center for Clinical Residency Program, Tottori University Hospital.
It has been reported that hyperuricemia might be responsible for cardiovascular diseases as well as gout and renal injury. Hypertension and hyperlipidemia, which are also responsible for cardiovascular diseases, are often associated with hyperuricemia. Thus, the treatment of hypertension and hyperlipidemia associated with hyperuricemia is also important. Losartan, an antihypertensive agent, and fenofibrate, an antihyperlipidemic agent, are known to have uric acid lowering effects. Both agents are useful for hyperuricemia with associated with hypertension and hyperlipidemia. In this section, we reported the characteristics and usefulness of these two agents in hyperuricemic patients with hypertension and hyperlipidemia.
http://www.ncbi.nlm.nih.gov/pubmed/1840 ... dinalpos=3
[Article in Japanese]
Ogino K, Igawa O, Hisatome I.
Center for Clinical Residency Program, Tottori University Hospital.
It has been reported that hyperuricemia might be responsible for cardiovascular diseases as well as gout and renal injury. Hypertension and hyperlipidemia, which are also responsible for cardiovascular diseases, are often associated with hyperuricemia. Thus, the treatment of hypertension and hyperlipidemia associated with hyperuricemia is also important. Losartan, an antihypertensive agent, and fenofibrate, an antihyperlipidemic agent, are known to have uric acid lowering effects. Both agents are useful for hyperuricemia with associated with hypertension and hyperlipidemia. In this section, we reported the characteristics and usefulness of these two agents in hyperuricemic patients with hypertension and hyperlipidemia.
Re: 請問可以開低劑量的降尿酸藥物給反覆高尿酸血症+痛風發作的患者嗎??
Effects of combination treatment using anti-hyperuricaemic agents with fenofibrate and/or losartan on uric acid metabolism
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754578/
Methods: Twenty seven patients with gout were included in a fenofibrate plus anti-hyperuricaemic agents combination study, and 25 in a losartan plus anti-hyperuricaemic agents combination study. Serum uric acid concentration, uric acid clearance, and 24 hour urinary uric acid excretion were measured before and two months after the addition of fenofibrate (300 mg once daily) or losartan (50 mg once daily) to anti-hyperuricaemic agents.
Results: Combination therapy of fenofibrate or losartan with anti-hyperuricaemic agents, which included benzbromarone (50 mg once daily) or allopurinol (200 mg twice a day), significantly reduced serum uric acid concentrations in accordance with increased uric acid excretion.
Conclusion: A combination of fenofibrate or losartan with anti-hyperuricaemic agents is a good option for the treatment of gout patients with hypertriglyceridaemia and/or hypertension, though the additional hypouricaemic effect may be modest.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754578/
Methods: Twenty seven patients with gout were included in a fenofibrate plus anti-hyperuricaemic agents combination study, and 25 in a losartan plus anti-hyperuricaemic agents combination study. Serum uric acid concentration, uric acid clearance, and 24 hour urinary uric acid excretion were measured before and two months after the addition of fenofibrate (300 mg once daily) or losartan (50 mg once daily) to anti-hyperuricaemic agents.
Results: Combination therapy of fenofibrate or losartan with anti-hyperuricaemic agents, which included benzbromarone (50 mg once daily) or allopurinol (200 mg twice a day), significantly reduced serum uric acid concentrations in accordance with increased uric acid excretion.
Conclusion: A combination of fenofibrate or losartan with anti-hyperuricaemic agents is a good option for the treatment of gout patients with hypertriglyceridaemia and/or hypertension, though the additional hypouricaemic effect may be modest.
Re: 請問可以開低劑量的降尿酸藥物給反覆高尿酸血症+痛風發作的患者嗎??
From 健保局:
http://210.69.65.1/nhicbe00/Q04.pdf
檔案備份網站:
http://www.badongo.com/file/20199497
第8頁:
Uricosuric drugs include probenecid, benzbromarone, micronised fenofibrate and losartan.
They are the urate-lowering drugs of choice in allopurinol-allergic patients and underexcretors with normal
renal function and no history of urolithiasis
-------------------
Similarly, treatment of selected hyperuricemic patients who also are hypertensive with losartan or amlodipine may be beneficial in lowering blood pressure and hyperuricemia.
--------------------
第8~9頁:
1.Uricosuric drugs
Probenecid
Benzbromarone
Fenofibrate micronized (Lipanthyl)
Losartan (Cozaar)
Amlodipine (Norvasc)
2.Uricostatic drugs(xanthine oxidase inhibitor)
Allopurinol
Oxipurinol
Febuxastat
Y-700
3.Uricolytic drugs
Urate oxidase (parenteral)
http://210.69.65.1/nhicbe00/Q04.pdf
檔案備份網站:
http://www.badongo.com/file/20199497
第8頁:
Uricosuric drugs include probenecid, benzbromarone, micronised fenofibrate and losartan.
They are the urate-lowering drugs of choice in allopurinol-allergic patients and underexcretors with normal
renal function and no history of urolithiasis
-------------------
Similarly, treatment of selected hyperuricemic patients who also are hypertensive with losartan or amlodipine may be beneficial in lowering blood pressure and hyperuricemia.
--------------------
第8~9頁:
1.Uricosuric drugs
Probenecid
Benzbromarone
Fenofibrate micronized (Lipanthyl)
Losartan (Cozaar)
Amlodipine (Norvasc)
2.Uricostatic drugs(xanthine oxidase inhibitor)
Allopurinol
Oxipurinol
Febuxastat
Y-700
3.Uricolytic drugs
Urate oxidase (parenteral)
