These twelve types of commonly used drugs will increase uric acid!

*It is only for medical professionals to read for reference.
In addition to dietary factors, many commonly used drugs can also increase uric acid levels, which we call drug-induced hyperuricemia
.

The overall prevalence of hyperuricemia in China has reached 13.
3%, becoming the second largest metabolic disease after diabetes [1]
.

Do you know? In addition to dietary factors, many commonly used drugs also increase uric acid levels, which we call drug-induced hyperuricemia
.

Let us clarify for you, which drugs should be used to raise uric acid? 01.
Diuretics are commonly used antihypertensive drugs, and the use of diuretics is very common
.

Many patients with hypertension also suffer from hyperuricemia.
At this time, attention should be paid to the use of thiazide-type and thiazide-like diuretics when formulating antihypertensive programs
.

Furosemide, hydrochlorothiazide, chlorthalidone, indapamide and other diuretics[2] can reduce the secretion and excretion of uric acid by the kidneys, increase the reabsorption of uric acid, and increase the level of uric acid
.

02.
Insulin activates urate transfer protein 1 (URAT1).
Insulin can promote the reabsorption of uric acid in the proximal tubules of the kidney and increase the level of uric acid
.

The data suggests that in patients with gout and diabetes, the blood uric acid level increases by an average of 75 μmol/L after insulin treatment [3].
If the patient's baseline uric acid level is high, it may cause hyperuricemia
.

Therefore, it is recommended that patients with both hyperuricemia and diabetes, if the condition permits, use insulin with caution
.

03.
Aspirin Aspirin has a two-way effect on uric acid levels.
Low-dose aspirin reduces the elimination of uric acid and may induce gout[4]
.

Large doses will organize the reabsorption of uric acid by the kidneys and ultimately reduce uric acid levels
.

The general clinical application of aspirin is mostly in small doses.
If there is an increase in uric acid, please do not arbitrarily stop the drug.
You can use it with caution while monitoring the uric acid level
.

04.
Niacin is a B vitamin.
It is used in the adjuvant treatment of hyperlipidemia.
It has an impact on the production and elimination of uric acid, but this effect is dose-dependent.
If a sustained-release preparation is used, it can be Reduce the risk of adverse reactions caused by elevated uric acid [5]
.

05.
Fructose sugar can promote the decomposition of adenosine triphosphate into adenosine, and then into hypoxanthine, and finally metabolize to produce uric acid.
Therefore, whether fructose is used as a solvent during rehydration or a large amount of fruits with higher fructose content may increase uric acid.
Level
.

06.
Pancreatin preparations These drugs are a mixture of various enzymes extracted from the arterial pancreas, including pancrelipase, trypsin, pancreatic amylase, etc.
Because they contain a large amount of purine components, long-term large-scale use will increase the level of uric acid
.

07.
Levodopa is a commonly used drug for the treatment of Parkinson's.
After entering the human body, levodopa will be metabolized into homovanillic acid and mandelic acid, both of which will compete for the excretion of uric acid, thereby reducing uric acid excretion and increasing uric acid levels
.

08.
Anti-tuberculosis drugs include pyrazinamide and ethambutol, both of which compete with uric acid for excretion channels, reduce uric acid excretion, and lead to hyperuricemia
.

09.
immunosuppressive agents include cyclosporine, tacrolimus and so on
.

Cyclosporine binds to calcium-binding proteins in the kidney, and by inducing the lipid peroxidation of renal cortical mitochondria and reducing the activity of related enzymes, it directly produces nephrotoxic effects, which in turn affects the secretion and excretion of uric acid in the blood
.

Tacrolimus can cause the contraction of renal glomerular arterioles in a dose-dependent manner, and some patients may experience kidney damage and elevated uric acid levels
.

10.
Tumor chemotherapeutic purine antagonists such as azathioprine, thioguanine, etc.
, have a similar structure to the human body's endogenous purines, and can generate uric acid derivatives under the action of enzymes in the body, or can increase uric acid levels
.

Methotrexate and its metabolites may be deposited in the renal tubules, leading to hyperuricemia nephropathy [5]
.

11.
Vitamin C Vitamin C is an acidic substance.
When used in large doses, it will increase the content of oxalate in urine by more than 10 times, causing hyperuricemia [6]
.

12.
Quinolones, such as norfloxacin, levofloxacin, ciprofloxacin, moxifloxacin, etc.
The mechanism of uric acid elevation is not clear, and may be related to competitive inhibition of uric acid excretion, kidney damage and secretion function
.

Have you got all the above points? What kind of drug-induced hyperuricemia have you encountered in the clinic? Welcome to comment and tell the editor
.

References: [1].
Chinese Medical Association Endocrinology Branch.
Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019).
Chinese Journal of Endocrinology and Metabolism, 2020, 36(1): 1-13.
[2].
Hypertension Alliance (China), Hypertension Branch of China Association for the Promotion of International Medical and Health Care, China Guidelines for Prevention and Treatment of Hypertension, etc.
China Guidelines for Prevention and Treatment of Hypertension (2018 Revised Edition).
Chinese Journal of Cardiology, 2019, 24(1): 25 .
[3].
MacFarlane LA, Liu CC, Solomon DH.
The effect of initiating pharmacologic insulin on serum uric acid levels in patients with diabetes: a matched cohort analysis.
Semin Arthritis Rheum.
2015, 44(5): 592-596.
[4].
Instructions for aspirin.
[5].
Zhou Jie.
Pathogenic drugs and prevention and treatment strategies for drug-induced hyperuricemia.
China Modern Drug Application, 2008(16): 108-110.
[6].
Qin Guijun.
Medicine Hyperuricemia.
Drug Evaluation, 12(7): 2015.
19-26.