Gout, Hyperuricemia Side Effect

Gout is an inflammatory arthritis resulting from the deposition of monosodium urate crystals from extracellular fluids saturated with urate, the product of human purine metabolism.

Hyperuricemia is a serum urate concentration exceeding approximately 6.8 mg/dL and reflects the tissue urate saturation, the central biochemical precursor for gout. Hyperuricemia results from impairment of renal uric acid excretion. Asymptomatic hyperuricemia is an initial stage of gout.

A number of medications can contribute to hyperuricemia and sometimes trigger gout by interfering with the renal tubular excretion of urate or by increasing the formation of uric acid2.

Loop and thiazide diuretics, salicylates, cyclosporin, antituberculosis medications have been associated with an increased uric acid levels.

List of drugs that induce or worsen hyperuricemia or precipitate acute gout:

Drug Incidence
Abilify Rare
Aceon 0.3% to 1%
Aciphex
Adalat < 1%
Advicor
Ambien Rare
Aricept Infrequent
Asacol
Aspirin aspirin dosages 75 mg/day have been shown to have an impact on serum urate levels1
Avalide
Avapro < 1%
Bextra 0.1% to 1.9%
Caduet < 2%
Campral Infrequent
Casodex 2% to 5%
CellCept 3% to 20%
Chlorthalidone (Thalitone®)3
Clorpres
Copaxone Infrequent
Coreg 1% to 3%
Cozaar < 1%
Demadex
Diovan > 0.2%
Edecrin
Effexor Rare
Ethambutol
Evoxac
Exelon Infrequent
Furosemide (Lasix®)
Geodon Rare
Gleevec Infrequent
HIVID < 1%
Hydrochlorothiazide (Microzide®, Esidrix®, Oretic®)3
Hytrin > 1%
Hyzaar
Invanz > 0.1%
Klonopin Infrequent
Levaquin 0.1% to 1%
Lexapro Infrequent
Lipitor < 2%
Lofibra
Lotensin 0.3% to 1%
Lotrel Infrequent
Mavik 0.3% to 1%
Maxzide
Micardis > 0.3%
Mirapex < 1%
Moduretic < 1%
Niacin
Niaspan
Nipent < 3%
Norvir < 2%
PEG-Intron < 1%
Paxil Rare
Permax Infrequent
Plavix 1% to 2.5%
Pletal < 2%
Prevacid < 1%
Prevpac < 1%
Priftin < 1%
Prinivil 0.3% to 1%
Prinzide
Protonix < 1%
Prozac Infrequent
Pyrazinamide4 inhibits renal tubular excretion of urate
Requip 1% or more
Reyataz < 3%
Rifater
Rilutek Infrequent
Rythmol
Sandostatin 1% to 4%
Seroquel Infrequent
Sonata Infrequent
Sular < 1%
Symbyax Rare
Synercid < 1%
Tarka Infrequent
Teveten < 1%
Tiazac 1% to 2%
Timolide
Tricor
Uniretic < 1%
Vantin < 1%
Vaseretic 0.5% to 2%
Viagra < 2%
Zaroxolyn
Zoladex 1% to 5%
Zyprexa Rare

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Risk factors

Factors that may precipitate gouty arthritis:

  • Excess dietary purines (e.g. meat, seafood)
  • High consumption of alcoholic beverages
  • Very high consumption of fructose
  • Obesity5 (particularly in older women)
  • High levels of triglycerides (hypertriglyceridemia)5
  • Underactive thyroid (hypothyroidism)
  • Hypertension 5
  • Early menopause

References

  • 1. Caspi D, Lubart E, Graff E, Habot B, Yaron M, Segal R. The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients. Arthritis Rheum. 2000 Jan;43(1):103-8. PubMed
  • 2. Scott JT. Drug-induced gout. Baillieres Clin Rheumatol. 1991 Apr;5(1):39-60. PubMed
  • 3. Wilson L, Nair KV, Saseen JJ. Comparison of new-onset gout in adults prescribed chlorthalidone vs. hydrochlorothiazide for hypertension. J Clin Hypertens (Greenwich). 2014 Dec;16(12):864-8. PubMed
  • 4. Solangi GA, Zuberi BF, Shaikh S, Shaikh WM. Pyrazinamide induced hyperuricemia in patients taking anti-tuberculous therapy. J Coll Physicians Surg Pak. 2004 Mar;14(3):136-8. PubMed
  • 5. Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention. Curr Opin Rheumatol. 2011 Mar;23(2):192-202. PubMed

Published: August 16, 2016
Last updated: December 12, 2017

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