Pyrazinamide Ethanol

Drugs that decrease renal clearance of uric acid through modification of filtered load or one of the tubular transport processes include diuretics, nicotinic acid, salicylates (less than 2 g/day), ethanol, pyrazinamide, levodopa, ethambutol, cyclosporine, and cytotoxic drugs. 

Pancreatic dysfunction, heralded by large increases in serum amylase and lipase, is associated with the use of several reverse-transcriptase inhibitors (RTIs). Didanosine appears to be the worst offender, and pancreatitis is the most characteristic adverse effect of this particular NRTI. Conditions enhancing susceptibility to drug-induced pancreatic dysfunction include hypertriglyceridemia, hypercalcemia, and history of excessive ethanol use. Liver dysfunction including hepatitis may occur with the antitu-bercular drugs, isoniazid, and pyrazinamide. Cholestasis is associated with the estolate form of erythromycin. 

In summary ethambutol produced a substantial increase in the serum urate concentration in 62% of patients receiving this agent for the treatment of tuberculosis. Further studies have shown that this drug produces a decrease in the renal clearance of uric acid. Although the exact basis for this effect is unclear, the effect of ethambutol appears to differ in one or more ways from other agents such as diuretics, ethanol, pyrazinamide and salicylates which have a similar net effect on uric acid clearance. 

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