This protocol targets a specific clinical situation: a patient with gout who is concurrently receiving strong P-glycoprotein and/or CYP3A4 inhibitors, and whose serum uric acid could not be controlled adequately with the previous urate-lowering approach.
This scenario applies to patients receiving one or more of the following agents alongside gout management:
Co-prescription of colchicine with these agents should be avoided. Strong P-glycoprotein and/or CYP3A4 inhibitors increase colchicine plasma concentration when co-prescribed, exposing patients to risk of serious side effects.
The preceding treatment step — involving agents such as febuxostat, uricosurics (benzbromarone, probenecid), or combinations with allopurinol — was unable to achieve serum uric acid below 6 mg/dL (360 mmol/L), or below 5 mg/dL (300 mmol/L) for patients with severe gout where complete crystal dissolution is the aim.
Failure to reach those targets is the trigger for escalation to this protocol.
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 crystal-proven, severe debilitating chronic tophaceous gout and poor quality of life, in whom the SUA target cannot be reached with any other available drug at the maximal dosage (including combinations), pegloticase is indicated.
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