January 26, 2023

Pharmacy pearls drug therapy that works week’s episode of pharmacy pearls i’m going to show you how to reduce the risk of guilt flares from starting treatment with allopurinol gout is a kind of arthritis caused by uric acid crystals forming in one or more joints uric acid is a waste product that forms when your body breaks down a substance called purines in people who

Have gout uric acid builds up and then forms sharp crystals inside the joints gout affects men more often than women although the gender gap narrows with age the annual incidence is one case for every a thousand men ages 40 to 44 and 1.8 cases for every a thousand men ages 55 to 64 high blood uric acid levels are the single most important risk factor approximately

60% of patients have a second attack within the first year and 78% have a second attack within two years by comparison only 7% of patients do not have her occurrence within a ten year period while a wait-and-see non-drug approach is sometimes justified after the first gout attack most experts recommend starting preventive treatment after two or three have occurred

The medication called allopurinol is the most widely prescribed agent for the long term prevention of recurrent gout attacks it works to lower blood uric acid levels by blocking its production in the body recently a second option for buxa stat entered the market with that being said there is one big problem uric acid lowering therapies actually trigger acute

Flares at the beginning of treatment in as many as 75 percent of patients this is because when blood uric acid levels drop uric acid crystals temporarily form in cartilage and soft tissues when a medication used to prevent gerd actually worsens it albeit temporarily it significantly lowers the likelihood that patients will adhere to treatment in order to deal with

This problem doctors often recommend using a medication called colchicine to prevent gout flares when starting allopurinol a 2004 randomized control trial published in the journal of rheumatology sought to determine the effectiveness of this approach by comparison comparing colchicine with placebo over six months and forty-three patients who are starting treatment

With allopurinol in the placebo group 77% of patients experienced a gout flare compared to only 33% of patients in the colchicine group thus over six months for every two to three people treated with colchicine a gout flare was prevented additionally colchicine decreased the average number and severity of flares the effect also persisted over the entire six-month

Period the dose of colchicine used in the study was 0.6 milligrams twice daily however if diarrhea occurred patients were encouraged to lower their dose to once daily while nausea abdominal discomfort and diarrhea are common with colchicine occurring in as many as 50 to 80 percent of patients all study participants were able to tolerate it this study does leave

Some unanswered questions for instance while once daily colchicine dosing was better tolerated by patients we do not know whether or not it is equally effective this could be further explored additionally a high proportion of study participants had advanced gout raising the question of how applicable the results are to less severe cases finally non-steroidal

Anti-inflammatory drugs such as ibuprofen are also recommended for the prevention of flares but evidence to support their use is lacking it would be nice to know how they compare with colchicine okay now you know how to reduce the risk of gout flares when starting treatment with allopurinol thanks for watching if you enjoyed this video please hit like and subscribe to my youtube channel

Transcribed from video
Preventing Gout Flares When Starting Allopurinol By Pharmacy Pearls