Certain ACEI classes: lenopril, ramipril
Decrease urate renal clearance
Hyperuricemia and gout occur at therapeutic doses. In contrast, captopril and enalapril significantly lower serum urate levels, acting like the ARB cloxacin, while other ARBs do not or rarely cause hyperuricemia.
Diuretics: furosemide, etanercept, hydrochlorothiazide, bumetanide, indapamide, torasemide
All diuretics: secondary to volume contraction and increased reabsorption of uric acid in the proximal tubule; thiazides: can also completely inhibit proximal tubule secretion
Increased uric acid influenced by dose and duration of administration
Pyrazinamide (PZA)
Drug or its metabolites (e.g., 5 – hydroxypyrazinic acid, a metabolite of PZA) compete with uric acid for organic acid excretion channels, reducing uric acid excretion.
Daily dosing is more likely to result in hyperuricemia than intermittent dosing. Gout attacks have occurred in patients with a history of gout
Ethambutol
Reduces urate renal clearance
Hyperuricemia and gout occur in most patients on oral doses of 20 mg/(kg・d)
Cyclosporine A (C s A)
Reduces urate renal clearance, either through the renal tubular mechanism or by decreasing GFR
Cyclosporine-induced hyperuricemia, which can cause gout, if the patient has the following risk factors: renal insufficiency, concomitant diuretics and male patients
Tacrolimus
Reduction of urate secretion
niacin
Occasional hyperuricemia and gout
Fergusine
Increases WBC production
Transient effect, commonly seen with high dose dosing (30-60ug/(kg・d))
Cytotoxic chemotherapy: adiponectin, asparagine, leucovorin, carboplatin, nitrogen mustard phenylbutyrate, cisplatin, cyclophosphamide, cytarabine, erythromycin, fludarabine, hydroxyurea, nitrogen mustard preparations, mercaptopurine, thioguanine, cetiapide, vincristine
Rapid cytolysis
Mainly seen in lymphoma and leukemia treatment, can lead to uric acid nephropathy, acute renal failure
Aspirin
Dual effect on uric acid metabolism, inhibiting re-secretion at low doses, causing uric acid retention; at high doses, preventing tubular reabsorption of urate and increasing uric acid excretion
Dose <2g/d causes hyperuricemia
Norfloxacin, ciprofloxacin, levofloxacin, etc.
The mechanism is still unknown, and may be related to the precipitation of crystals in the renal tubules under neutral or alkaline environment, causing renal organic damage and disturbance of renal tubular secretion function.
Entericase capsule
Intake of pancreatic enzyme products rich in purine components
Hyperuricemia, hyperuricuria and uric acid crystalluria can occur at high doses.
L-dopa
Inhibits urate secretion
Patients taking therapeutic doses have a history of hyperuricemia and gout. Second, increased false positives interfere with colorimetric determination of uric acid
Inosine
Inosine is a hypoxanthine nucleoside, which is an intermediate product of purine metabolism and is used as an exogenous uric acid precursor to raise uric acid.
Patients taking >9.6mg/(kg/d) orally will have an increase in uric acid.
Fructose
Reduces hepatic ATP synthesis and leads to accelerated uric acid production
Hyperuricemia is seen after rapid infusion (500mg/h). Avoid use in patients with gout and cirrhosis
Ethanol
Can induce impaired glycogen isogenesis, leading to the accumulation of lactic acid and ketone bodies in the body. B C hydroxybutyric acid in lactate and ketone bodies competitively inhibits uric acid excretion.
Associated with acute gout
Glucocorticoids
tumor regression
Seen when glucocorticoids are used as antineoplastic agents
Isotretinoin
vitamin A excess disorder
hyperuricemia, rare cases of gout
Viridazole and interferon
Mechanism unclear; generally associated with hemolysis
Nephrolithiasis can occur in patients with diabetes mellitus and hypertension; hyperuricemia occurs in approximately 24% of these patients treated with concomitant interferon
Theophylline
Interferes with uric acid measurement
False positive elevation
Nicergoline
No correlation with dose and duration of administration
Sulfonylureas such as glibenclamide, glimepiride, and gliclazide
Long-term use can affect renal function, reduce uric acid excretion, and increase blood uric acid.