title: Safety profile of anti-gout agents: an update.
abstract: OBJECTIVE
  Recent interest in gout has led to development of new drugs for acute gout and long-term urate-lowering, as well as interest in improving the use of older drugs. The patients' comorbidities and concomitant medications may contribute to the risk of adverse drug reactions with anti-gout therapies. This review will highlight recent data on the safety of drugs used in gout.
  
  
  RESULTS
  Colchicine has a narrow therapeutic index, and low doses are effective with less gastrointestinal toxicity. There are significant interactions between colchicine and CYP3A4 and P-glycoprotein inhibitors, and the colchicine dose must be reduced. Allopurinol and febuxostat have similar adverse effect profiles. Recent data have highlighted the risk association of HLA-B5801 in some ethnic groups and of allopurinol starting dose in allopurinol hypersensitivity syndrome. Further long-term cardiovascular safety data in patients with cardiovascular disease or cardiovascular risk factors receiving febuxostat and allopurinol are pending. Infusion reactions are common in patients receiving pegloticase, particularly in patients with pre-infusion serum urate above 0.36mmol/l (6 mg/dl).
  
  
  CONCLUSIONS
  In general, treatments for gout are well tolerated, although clinicians must keep in mind the potential for drug interactions and the contribution of comorbidities to the potential for adverse effects with gout therapies.
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Stamp
mesh_terms: D000493:Allopurinol / Q000009:adverse effects; D003078:Colchicine / Q000009:adverse effects; D004347:Drug Interactions; D000069465:Febuxostat; D006073:Gout / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D006074:Gout Suppressants / Q000009:adverse effects*; D015235:HLA-B Antigens / Q000235:genetics; D006801:Humans; D007375:Interleukin-1 / Q000037:antagonists & inhibitors; D011092:Polyethylene Glycols / Q000009:adverse effects; D012307:Risk Factors; D012449:Safety; D013844:Thiazoles / Q000009:adverse effects; D014503:Urate Oxidase / Q000009:adverse effects
chemical_list: D006074:Gout Suppressants; D015235:HLA-B Antigens; C500126:HLA-B*58:01 antigen; D007375:Interleukin-1; D013844:Thiazoles; D000069465:Febuxostat; D011092:Polyethylene Glycols; D000493:Allopurinol; D014503:Urate Oxidase; C031545:Pegloticase; D003078:Colchicine