10.9 Antigout Medications
Antigout medications are used to treat gout, a musculoskeletal disorder. Allopurinol is commonly used to prevent gout from recurring. Colchicine, classified as anti-inflammatory medication, is used to prevent and treat acute gout flares.
Allopurinol
Mechanism of Action: Allopurinol blocks the production of uric acid by inhibiting the action of xanthine oxidase.
Indications: Allopurinol is used for the prevention of gouty arthritis and for the treatment of secondary hyperuricemia.
Nursing Considerations: Allopurinol is safe for all ages. For clients with renal impairment, the dose will be reduced.
Side Effects/Adverse Effects: Adverse effects include hypotension, flushing, drowsiness, nausea and vomiting, diarrhea, hepatitis, renal failure, drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, or drug hypersensitivity syndrome.[1]
Health Teaching & Health Promotion: The medication should be taken as directed. An alkaline diet may be ordered for the client, and they may be advised to increase fluid intake to prevent kidney stone formation. The medication may cause dizziness or drowsiness. Clients who consume large amounts of alcohol may increase uric acid concentrations and decrease the effectiveness of the medication. If a client develops a rash or blood in the urine, these new symptoms should be reported promptly to the health care provider.[2]
Colchicine
Mechanism of Action: Colchicine has primarily anti-inflammatory properties.
Indications: Colchicine is indicated for prophylaxis and the treatment of acute gout flares.
Nursing Considerations: The recommended dosage of colchicine depends on the client’s age, renal function, hepatic function, and use of co-administered drugs. Colchicine is not an analgesic medication and should not be used to treat pain from other causes. It is administered orally without regard to meals.
Side Effects/Adverse Effects: The most commonly reported side effect of colchicine is diarrhea. Life-threatening and fatal drug interactions have been reported in clients treated with colchicine given with P-gp and strong CYP3A4 inhibitors. Myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses. Colchicine-induced neuromuscular toxicity and rhabdomyolysis have been reported in elderly clients and those with renal dysfunction.
Health Teaching & Health Promotion: Clients should be instructed to take colchicine as prescribed, even if they are feeling better. Clients should not alter the dose or discontinue treatment without consulting with their provider. They should report to their health care provider all of the current medications they are taking and check before starting any new medications, particularly antibiotics, as well as nonprescription medication or herbal products. Grapefruit and grapefruit juice may also interact and should not be consumed during colchicine treatment. Client