ماذا تفعل عند فشل علاج نوبة النقرس الحادة لدى المرضى الذين يتناولون مثبطات P-glycoprotein و/أو CYP3A4 القوية

References

DOI: 10.1136/annrheumdis-2016-209707

• Colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors such as cyclosporin or clarithromycin.
• Co-prescription of colchicine with strong P-glycoprotein and/or CYP3A4 inhibitors should be avoided.
• A pharmacokinetic study showed that strong P-glycoprotein and/or CYP3A4 inhibitors such as cyclosporin, clarithromycin, verapamil and ketoconazole when prescribed with colchicine increased colchicine plasma concentration, thereby exposing patients to risk of serious side effects.
• In patients with normal kidney function, allopurinol is recommended for first-line ULT, starting at a low dose (100 mg/day) and increasing by 100 mg increments every 2-4 weeks if required, to reach the uricaemia target.
• If colchicine is not tolerated or is contraindicated, prophylaxis with NSAIDs at low dosage, if not contraindicated, should be considered.
• Every person with gout should receive advice regarding lifestyle: weight loss if appropriate and avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals and excessive intake of meat and seafood.
• Low-fat dairy products should be encouraged.
• Regular exercise should be advised.