Gout treatment chronic hyperuricemia

Allopurinol is used in the treatment of hyperuricemia, which is associated with chronic gout and in cancer chemotherapy. Allopurinol has been used in renal calculi caused by the deposition of calcium oxalate and of 2,8-dihydroxy-adenine. Allopurinol treatment does cause hypersensitivity reaction, which may be fatal. 

Febuxostat (1), approved by the FDA on February 16, 2009, is a urate-lowering drug which inhibits xanthine oxidase and which is indicated for the use in the treatment of hyperuricemia and chronic gout. The approval of febuxostat (1) marked a significant advance in the deatment of gout. In comparison to allopurinol (5), febuxostat (1) is a novel non-purine selective inhibitor of xanthine oxidase. In this chapter, the pharmacological profile and syntheses of febuxostat (1) will be profiled in detail. ... 

Pharmaceutical therapy of acute arthritis of crystal-deposition disease is effective, in particular for gout and hyperuricemia. Treatment is directed towards termination of acute arthritis, prevention of recurring attacks and prophylaxis and reversal of complications of chronic gout. Such complications include tophi, urolithiasis, nephropathy and with hyperuricemia associated medical problems that can be prevented, inhibited, and sometimes reversed. 

Before starting chronic therapy for gout, patients in whom hyperuricemia is associated with gout and urate lithiasis must be clearly distinguished from those who have only hyperuricemia. In an asymptomatic person with hyperuricemia, the efficacy of long-term drug treatment is unproved. In some individuals, uric acid levels may be elevated up to 2 standard deviations above the mean for a lifetime without adverse consequences. 

The therapy of gout is twofold (1) treatment of the acute attack and (2) chronic lowering of hyperuricemia. 

Assuming no treatment of asymptomatic hyperuricemia, pharma-coeconomic considerations apply only to the management of the acute and chronic clinical manifestations of gout. 

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