Gout Medicine Allopurinol Side Effects

Renal disease has been a barrier to effective management of gout. Abnormal renal function is associated with an increased risk of the allopurinol hypersensitivity syndrome. Issues related to allopurinol dosing in renal insufficiency and strategies for reducing the risk of allopurinol hypersensitivity are discussed previously in the section on febuxostat.

Cardiovascular disease is important in gout because it is known that patients with gout are at higher cardiovascular risk. Some medications for acute gout, such as NSAIDs and prednisone, may be problematic in patients with congestive heart failure. In the hospital, clinicians may need to turn to anakinra therapy to avoid fluid retention in heart failure patients with gout flares. A recent article on cardiovascular safety of febuxostat versus allopurinol is discussed previously.

Elderly patients with gout often have decreased eGFR, making NSAIDs for acute flares problematic. Other comorbidities, such as diabetes and hypertension, likewise need consideration in gout medication choice. Cognitive issues may make education and monitoring more difficult. Elderly patients are often on multiple medications that may have interactions with colchicine. Amiodarone raises colchicine levels, as do most statin drugs (but not rosuvastatin), and the greatest increases of colchicine levels are seen with cyclosporine and clarithromycin (NEXT: **Gout Treatment Guidelines**)