النقرس عند فشل الألوبيورينول في المرضى الذين يتناولون مثبطات قوية لـ P-glycoprotein و/أو CYP3A4

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.
• If the SUA target cannot be reached by an appropriate dose of allopurinol, allopurinol should be switched to febuxostat or a uricosuric, or combined with a uricosuric.
• Febuxostat is a potent non-purine selective XOI approved at daily doses of 80 and 120 mg in Europe.
• Benzbromarone (50–200 mg/day) is a more potent uricosuric as compared with probenecid (1–2 g/day).
• For patients on ULT, SUA level should be monitored and maintained to <6 mg/dL (360 mmol/L).
• A lower SUA target (<5 mg/dL; 300 mmol/L) to facilitate faster dissolution of crystals is recommended for patients with severe gout (tophi, chronic arthropathy, frequent attacks) until total crystal dissolution and resolution of gout.