醫聲論壇

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↑

5 以上都可以
半年抽血一次

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↑

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↑

我懷疑沒驗準
UA 應該不會驟升才對

smallant 寫: 我懷疑沒驗準
UA 應該不會驟升才對

莫宰羊ㄟ...

驗出來就是這樣...

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↑

劑量增加，因為gout的UA goal是 < 5.0。

如果腎功能異常或有痛風石、尿路結石，則使用Allopurinol。

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.

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.

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.

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)