Uric acid lowering benzbromarone or febuxostat?

Febuxostat and benzbromarone occupy half of the gout-lowering uric ac.

Febuxostat and benzbromarone occupy half of the gout-lowering uric ac.

Although the major guidelines do not make clear provisions for the choice of the t.

For the choice of febuxostat or benzbromarone to lower uric acid, the indications, contraindications, and the type of hyperuricemia should be considered comprehensive.

01 mode of action01 mode of action

Inhibition of uric acid synthesis ( hyperuricemia ): Febuxost.

Inhibition of uric acid synthesis ( hyperuricemia ): Febuxost.

Promotes the excretion of uric acid (hypouric acid type ): benzbromaro.

Therefore, for patients with renal dysfunction, the effect of benzbromarone will be much lower than that of normal people, and drugs that inhibit uric acid synthesis usually have a wider audien.

02 How to choose?

02 How to choose? 02 How to choose?

The uric acid-lowering drugs should be reasonably selected according to the type of hyperuricemia, the presence or absence of urinary calculi, and liver and kidney function in gout patien.

The uric acid-lowering drugs should be reasonably selected according to the type of hyperuricemia, the presence or absence of urinary calculi, and liver and kidney function in gout patien.

(1) Quantitative determination of uric acid in 24 hours: keep urine for 24 hours, and measure the excretion of uric ac.

Ordinary diet: Ordinary diet: uric acid <800mg/24 hours is hypouric acid excretion type, >800mg/24 hours is uric acid hyperproducing type;

Low-purine diet: uric acid <600mg/24 hours is hypouric acid excretion type, > 600mg/24 hours is uric acid hyperproduction type; the two are mixed ty.

Low-purine diet: Low-purine diet: uric acid <600mg/24 hours is hypouric acid excretion type, >600mg/24 hours is uric acid hyperproduction type; the two are mixed ty.

(2) Determination of uric acid clearance rate: Accurately collect urine for 60 minutes, and collect blood to measure blood uric acid at the same time, and calculate the ratio of uric acid excretion per minute to blood uric acid value (2) Determination of uric acid clearance rate: Accurately collect urine for 60 minutes, and collect blood for blood measurement For uric acid, calculate the ratio of uric acid excretion per minute to blood uric acid value (uric acid * urine volume per minute / blood uric acid), and the normal range is 6 to 16 ml/m.

(3) Determination of the ratio of uric acid clearance to creatinine clearance: (3) Determination of the ratio of uric acid clearance to creatinine clearance: Cua/Ccr × 100%, if it is more than 10%, it belongs to the overproduction type, and <5% belongs to excreti.

(4) Classification according to clinical experience: (4) Classification according to clinical experience:

Patients with hyperuricemia are usually characterized by: binge eating, high purine diet; severe infection ; tissue destruction such as leukemia , myeloma, polycythemia, and myolysis; the use of chemotherapy drugs,e.

Patients with hyperuricemia are usually characterized by: binge eating, high purine diet; severe infection ; tissue destruction such as leukemia , myeloma, polycythemia, and myolysis; the use of chemotherapy drugs,e.

Patients with hyperuricemia are usually characterized by: infection with leukemia

Patients with hypouric acid excretion are usually characterized by: a regular diet without the above conditions, but also high uric acid; long-term heavy drinking; long-term use of diuretics and aspirin;

Patients with hypouric acid excretion usually have the following characteristics: patients with hypouric acid excretion are usually characterized by: a regular diet, without the above conditions, but also high uric acid; long-term heavy drinking; long-term use of diuretics, aspirin; anti-tuberculosis drugs, e.

All cases belong to the hypouric acid excretion ty.

 

 

03 Metabolism

03 Metabolism 03 Metabolism

 

Excretion by the kidneys: febuxost.

Excretion through the kidneys:Excretion through the kidneys: febuxost.

 

 

Excretion through the biliary tract: benzbromaro.

Excretion through biliary tract:Excretion through biliary tract: benzbromaro.

 

 

Both drugs are metabolized in the liver to convert their activities and cause damage to the liv.

Febuxostat should be used with caution in patients with kidney disea.

Both drugs are metabolized in the liver to convert their activities and cause damage to the liv.

Febuxostat should be used with caution in patients with kidney disea.

 

 

 

04 Adverse reactions

04 Adverse reactions04 Adverse reactions

 

Febuxostat

1, febuxostat 1, febuxostat

 

 

(1) It may cause liver function damage, so be sure to monitor changes in liver function when taking this dr.

(1) It may cause liver function damage, so be sure to monitor changes in liver function when taking this dr.

 

 

(2) It may cause acute gout atta.

This drug lowers blood uric acid levels too quickly, causing urate deposits in the joints to move, causing gout flar.

Therefore, when taking this drug, the dosage should be gradually increased from a small dose, and colchicine + non-steroidal anti-inflammatory drugs should be used for back.

(2) It may cause acute gout atta.

This drug lowers blood uric acid levels too quickly, causing urate deposits in the joints to move, causing gout flar.

Therefore, when taking this drug, the dosage should be gradually increased from a small dose, and colchicine + non-steroidal anti-inflammatory drugs should be used for back.

 

 

(3) May increase the risk of cardiovascular disease, as well as allergic reactions

(3) May increase the risk of cardiovascular disease, as well as allergic reactions to blood vessels

 

Benzbromarone

BenzbromaroneBenzbromarone

 

 

There are few adverse effects, the main reaction is digestive tract irritation, and possible damage to liver and kidney functi.

There is an increased risk of stones, and patients with stones should not choose benzbromaro.

There are few adverse effects, the main reaction is digestive tract irritation, and possible damage to liver and kidney functi.

There is an increased risk of stones, and patients with stones should not choose benzbromaro.

Digestion

 

 

 

 

05 Application in patients with abnormal liver and kidney function

05 Application in patients with abnormal liver and kidney function 05 Application in patients with abnormal liver and kidney function

 

Application of febuxostat and benzbromarone in abnormal liver function

Application of febuxostat and benzbromarone in
abnormal liver functionApplication of febuxostat and benzbromarone in abnormal liver function

 

 

Note: According to the total score of the above 5 items, the classification is judged: Child-Pugh A (5-6 points), Child-Pugh B (7-9 points), Child-Pugh C (≥10 points), and A has the highest prognos.

Well, class C is the wor.

Child-Pugh

 

Application of febuxostat and benzbromarone when renal function is abnormal

Application of febuxostat and benzbromarone when renal function is abnormalApplication of febuxostat and benzbromarone when renal function is abnormal

 

 

 

06 Combination medication

06 Combination medication06 Combination medication

 

Both febuxostat and benzbromarone have the risk of liver dama.

Taking these two drugs at the same time significantly increases the incidence of liver damage, especially in patients with hepatic insufficien.

For the vast majority of gout patients, it is far from the point where combined medication is requir.

Increasing the dose of a single uric acid-lowering drug, or switching to other uric acid-lowering drugs, can solve the problem of substandard uric ac.

Therefore, it is not recommended to use bo.

Both febuxostat and benzbromarone have the risk of liver dama.

Taking these two drugs at the same time significantly increases the incidence of liver damage, especially in patients with hepatic insufficien.

For the vast majority of gout patients, it is far from the point where combined medication is requir.

Increasing the dose of a single uric acid-lowering drug, or switching to other uric acid-lowering drugs, can solve the problem of substandard uric ac.

Therefore, it is not recommended to use bo.

 

 

 

07 Summary

07 Summary07 Summary

 

For gout patients, it is recommended to start uric acid-lowering therapy 2 to 4 weeks after the gout attack is reliev.

If a gout attack occurs during the treatment, it is not recommended to stop uric acid-lowering dru.

For gout patients, it is recommended to start uric acid-lowering therapy 2 to 4 weeks after the gout attack is reliev.

If a gout attack occurs during the treatment, it is not recommended to stop uric acid-lowering dru.

 

 

In the selection of drugs, it is necessary to correctly determine whether the cause is excessive uric acid synthesis, or excretion disorders, or bo.

Rational drug use should be carried out through the etiology, medical history, medication history and comorbidities, and long-term monitoring of uric acid, liver and kidney function changes, to avoid adverse reactions, and strive to obtain the best curative effe.

In the selection of drugs, it is necessary to correctly determine whether the cause is excessive uric acid synthesis, or excretion disorders, or bo.

Rational drug use should be carried out through the etiology, medical history, medication history and comorbidities, and long-term monitoring of uric acid, liver and kidney function changes, to avoid adverse reactions, and strive to obtain the best curative effe.

 

references

references

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Chinese Journal of General Practitioners, 2020(04):293-30

[1] Guidelines for primary diagnosis and treatment of gout and hyperuricemia (2019) [.

Chinese Journal of General Practitioners, 2020(04): 293-30 Diagnosis and treatment

[2] Luo Hao, Qin Qiaojun, Wei Guangping, et .

Research progress on the pathogenesis, diagnosis and treatment of gout [.

Internal Medicine, 2019,14(01):47-5

[2] Luo Hao, Qin Qiaojun, Wei Guangping, et .

Research progress on the pathogenesis, diagnosis and treatment of gout [.

Internal Medicine, 2019,14(01):47-5

[3] Li Lin, Zhu Xiaoxia, Dai Yuxiang, et .

Multidisciplinary expert consensus on the diagnosis and treatment of hyperuricemia-related diseases in China [.

Chinese Journal of Internal Medicine, 2017,56(03):235-24

[3] Li Lin, Zhu Xiaoxia, Dai Yuxiang, et .

Multidisciplinary expert consensus on diagnosis and treatment of hyperuricemia-related diseases in China [.

Chinese Journal of Internal Medicine, 2017, 56(03): 235-24 Consensus

[4] Yu Xueqing, Chen W.

Expert consensus on the diagnosis and treatment of hyperuricemia in patients with chronic kidney disease in China [.

Chinese Journal of Nephrology, 2017,33(06):463-46

[4] Yu Xueqing, Chen W.

Expert consensus on the diagnosis and treatment of hyperuricemia in patients with chronic kidney disease in China [.

Chinese Journal of Nephrology, 2017,33(06):463-46

[5] Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019) [.

Chinese Journal of Endocrinology and Metabolism, 2020(01): 1-1

[5] Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019) [.

Chinese Journal of Endocrinology and Metabolism, 2020(01): 1-1Leave a message here