Treatment of chronic or intermittent gouty arthritis and tophaceous gout.
Used in patients with frequent disabling attacks of gout.
Used when tophi are visible or serum urate concentrations are >8.5–9 mg/dL in patients with family history of tophi or low uric acid excretion.
Not recommended for management of asymptomatic hyperuricemia; however, some clinicians initiate therapy when serum urate concentrations are >9 mg/dL (by colorimetric method) because such concentrations often are associated with increased joint changes and renal complications.
Goal of therapy is to lower serum urate concentrations to about 6 mg/dL.
Alternative to probenecid, which generally is better tolerated. May be used with allopurinol for additive effect, especially in the presence of tophaceous deposits. May be used with probenecid if the uricosuric response to one drug is insufficient at maximum therapeutic dosage.
Not effective in patients with moderate to severe chronic renal insufficiency. (See Renal Impairment under Cautions.)
Of no value in the treatment of acute gout attacks. (See Actions and also see Acute Gout under Cautions.)
Hyperuricemia Secondary to Other Causes
Has been used effectively and is commonly employed to promote uric acid excretion in hyperuricemia secondary to administration of thiazide and related diuretics†, furosemide†, ethacrynic acid†, pyrazinamide†, or ethambutol†.
Do not use to treat hyperuricemia secondary to cancer chemotherapy, radiation, or myeloproliferative neoplastic diseases; may increase risk of uric acid nephropathy.
Platelet Aggregation Inhibition
Has been used to decrease platelet aggregation and increase platelet survival time in cardiovascular disorders†, including angina, MI, TIAs, amaurosis fugax, peripheral arterial atherosclerosis, DVT and recurrent venous thrombosis, and in patients with arteriovenous dialysis shunts and prosthetic mitral valves.
Not associated with benefit in patients with unstable angina or non-ST-segment elevation MI†; not recommended by ACC/AHA as antiplatelet therapy in such patients.
Has been used to maintain graft patency in patients undergoing CABG surgery†; however, not consistently effective and not recommended by the American College of Chest Physicians (ACCP) for this use.
Dosage and Administration
General
All patients should maintain daily urine output at ≥2–3 L; alkalinization of urine desirable.
Administration
Oral Administration
Take with meals, milk, or antacids to minimize adverse GI effects.
Dosage
Adjust dosage according to the response and tolerance of the patient.
Use low dosages initially to reduce possibility of acute gout attacks and prevent massive uricosuria.
Adults
Hyperuricemia Associated with Gout
Oral
Initially, 100–200 mg twice daily during the first week of therapy, then increase as needed to full maintenance dosage of 200–400 mg twice daily. Serum urate concentrations usually fall to minimum levels within a few days; once controlled, may attempt to reduce dosage to 200 mg daily in divided doses.
Patients previously controlled with other uricosuric therapy may begin sulfinpyrazone at full maintenance dosage.
Uricosuric therapy should be continued indefinitely and without interruption; irregular dosage schedules may result in increased serum urate concentrations.
Inhibition of Platelet Aggregation
Oral
600–800 mg daily has been used.†
Special Populations
Hepatic Impairment
No specific dosage recommendations at this time.
Renal Impairment
No specific dosage recommendations at this time. (See Renal Impairment under Cautions.)
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