A 50-year-old man with gout has a serum urate of 9 mg/dL, a 24-hour urinary uric acid excretion of 250 mg on a purine-restricted diet, and normal renal function with no stones. Which drug class is most appropriate as monotherapy for his urate lowering?
- A Xanthine oxidase inhibitor
- B Interleukin-1 receptor antagonist
- C Recombinant uricase
- D Uricosuric agent such as probenecid ✓
Explanation
Most patients with gout are underexcretors, defined by urinary uric acid below about 600 mg per day on a regular diet, and this patient's low excretion with preserved renal function and no nephrolithiasis makes him an ideal candidate for a uricosuric drug. Probenecid inhibits the URAT1 transporter and OAT-mediated reabsorption of urate in the proximal tubule, increasing urinary urate loss. Xanthine oxidase inhibitors suit overproducers, recombinant uricase is reserved for refractory tophaceous disease, and IL-1 blockers treat flares, not hyperuricaemia.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.