Arthur Kavanaugh, MD

Disclosures

February 28, 2008

Question

Dr. Kavanaugh's article on treatment options for gout did not include the possibility of using probenecid (Benemid) (review the article at http://www.medscape.com/viewarticle/563931). Is there a specific reason for this omission?

Craig Borgardt, RPh

Response From the Expert

Arthur Kavanaugh, MD
Professor, Department of Rheumatology, University of California, San Diego


The omission of probenecid as a potential therapy for gout was based only on a personal view of practical considerations. Certainly, this drug has uricosuric effects by inhibiting renal tubular reabsorption of uric acid and can therefore lower serum uric acid levels. It is recommended for patients with gout who are not "hypersecretors" (eg, > 800 mg uric acid in a 24-hour urine sample).

The advantage of probenecid is its relatively low cost. It has a long history of use with experience worldwide in large numbers of patients. However, in my personal experience I have not found probenecid to be useful in many patients with gout. A major contributing factor is its lesser efficacy among patients with diminished renal function, a common comorbidity in patients with gout. Also, because many of my patients tend to be those with the most severe forms of gout (eg, chronic tophaceous gout), I have not typically used probenecid as a mainstay of therapy. In addition, this medication can cause an array of adverse effects. Although these side effects are generally mild, they can be bothersome to patients, and may make the patients less accepting to continued therapy.

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