痛風與高尿酸血症的藥物治療 衛生福利部臺北醫院藥劑科藥師鄭金松 摘要 gout hyperuricemia 臨床藥Therapeutics of Clinical Drugs 物治療學壹 痛風與高尿酸血症 1 2 2012 1.2% 3 3.09 0.53 < 7.0 mg/dl 90 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.3 Sep. 30 2015 0.1% 7.0-8.9 mg/dl 0.5% 9.0 mg/dl 4.9% 4 > 7.0 mg/dl ( 10-15%) ( 85-90%) 5 貳 痛風病程分期與診斷一 無症狀的高尿酸血症 (90%) 2
藥學雜誌 124 91 二 急性痛風期 2 三 間歇期 62% 78% 6 四 慢性痛風期 (tophi) 2 1977 7 參 藥物治療一 無症狀高尿酸血症的治療 8,9 臨床 藥物治療 學 二 急性痛風關節炎的藥物治療 1-2 (NSAIDs) (colchicine) (corticosteroid) 1 ( 一 ) 非類固醇消炎止痛藥 (NSAIDs) NSAIDs NSAIDs 24 NSAIDs NSAIDs 1 ( 二 ) 秋水仙素 (colchicine) 24 FDA 24 1.2 mg colchicine 0.6 mg colchicine 1.8 mg colchicine 3-6 colchicine 10 colchicine Colchicine P-glycoprotein 31 3 Sep. 30 2015
臨床藥Therapeutics of Clinical Drugs 物治療 CYP3A4 學 1 ( 三 ) 類固醇 (corticosteroid) NSAIDs colchicine 1-2 prednisolone 30-60 mg 1 三 不發作間歇期及慢性痛風石關節炎的治療 3-6 colchicine 2 (xanthine oxidase inhibitor) ( 一 )Xanthine oxidase inhibitors 1.Allopurinol xanthine oxidase Allopurinol 1-3 oxypurinol 17-40 92 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.3 Sep. 30 2015 Allopurinol Allopurinol allopurinol (allopurinol hypersensitivity syndrome, AHS) Steven-Johnson syndrome allopurinol 50 300 mg 800 mg allopurinol ampicillin thiazide ACEI warfarin azathioprine mercaptopurine 1 2.Febuxostat xanthine oxidase Febuxostat 40 mg 80 mg 1 ( 二 ) 促尿酸排泄藥物 Benzbromarone probenecid sulfinpyrazone
藥學雜誌 124 93 1 1.Benzbromarone 25-50 mg 100 mg CCr < 20 ml/min Benzbromarone 2 2.Probenecid 250 mg 500-2000 mg probenecid penicillins cephalosporins rifampicin 1 3.Sulfinpyrazone 臨床 藥物治療 50 mg 2 學 100-400 mg Sulfinpyrazone sulfonylurea warfarin 1 肆 結語 6 mg/dl 31 3 Sep. 30 2015 Pharmacotherapy of Gout and Hyperuricemia Chin-Sung Cheng Department of Pharmacy, Taipei Hospital, Ministry of Health and Welfare Abstract Gout is characterized biochemically by extracellular fluid urate saturation. All patients
with gout have hyperuricemia at some point in their disease. However, most hyperuricemic individuals never experience a clinical event resulting from urate crystal deposition. The four classic stages in the natural history of progressive gout are: (1)Asymptomatic hyperuricemia, (2)Acute gouty arthritis, (3)Intercritical (or interval) gout, (4)Chronic recurrent and tophaceous gout. The goal of therapy in an acute gout attack is prompt and safe termination of pain and disability. Symptoms improve more quickly with administration of any of a broad array of antiinflammatory drugs. The approach to prevention of acute attacks during this interval or chronic stage includes both lifestyle changes and medical management. 參考資料 : Therapeutics of Clinical Drugs 臨床藥物治療學94 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.3 Sep. 30 2015 1. Ernst ME, Clark EC: Gout and Hyoeruricemia.In: DiPiro JT, Talbert RL, Yee GY, eds. Pharmacotherapy, 8th ed. New York. McGraw-Hill, 2011:1621-32. 2. 2013 2013;5. 3. Chen JH, Yeh WT, Chuang SY., et al: Gender-specific risk factors for incident gout: a prospective cohort study. Clin Rheumatol 2012; 31: 239-45. 4. Campion, E.W., Glynn R.J., and DeLabry L.O. Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med 1987; 82:421-6. 5. Wyngaarden JB, Kelley WN: Gout and Hyperuricemia. New York. Grune and Stratton, 1976. 6. Gutman AB: Gout and gouty arthritis.in: Beeson PB, McDermott W, eds. Textbook of Medicine. Philadelphia. Saunders, 1958:595. 7. Wallace SL, Robinson H, Masi AT, et al: Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977; 20: 895-900. 8. Lin, K.C., H.Y. Lin, and P. Chou. The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol 2000; 27: 1501-5. 9. Choi HK, Atkinson K, Karlson EW, et al: Obesity, weight change, hypertension, diureticuse, and risk of gout in men: the health professionals follow-up study. Arch Intern Med 2005; 165: 742-8. 10. Borstad GC, Bryant LR, Abel MP, et al: Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol 2004; 31: 2429-32.