Author: Cherry
Source: Medical Cardiovascular Channel
The overall prevalence of hyperuricemia in China has reached 13.3%, making it the second largest metabolic disease after diabetes[1] span>.
Did you know? In addition to dietary factors, many commonly used drugs can also increase uric acid levels, which we call drug-induced hyperuricemia.
Let us clarify for you, which drugs should be used to be careful of elevated uric acid?
01. Diuretics
As commonly used antihypertensive drugs, the Use is common. Many hypertensive patients also suffer from hyperuricemia at the same time. At this time, attention should be paid to thiazide and thiazide-like diuretics when formulating antihypertensive regimens. Diuretics such as furosemide, hydrochlorothiazide, chlorthalidone, and indapamide[2] can reduce the secretion and excretion of uric acid by the kidneys , increases the reabsorption of uric acid and increases the level of uric acid.
02.Insulin
By activating urate transporter 1 (URAT1), insulin can promote the reabsorption of uric acid in proximal renal tubules and increase the level of uric acid. The data suggest that, in patients with gout and diabetes, the average serum uric acid level increases by 75 μmol/L after insulin treatment.[3] Higher levels may cause hyperuricemia. Therefore, it is recommended that for patients with both hyperuricemia and diabetes, insulin should be used with caution if the condition permits.
03. Aspirin
The effect of aspirin on uric acid levels is bidirectional. Low-dose aspirin reduces the elimination of uric acid and may induce gout[4] . Large doses prevent the reabsorption of uric acid by the kidneys, ultimately lowering uric acid levels. Generally, aspirin is used in small doses in clinical practice. If uric acid is elevated, do not stop the drug arbitrarily. It can be used with caution while monitoring the level of uric acid.
04. Niacin
This is a B vitamin that is used in the adjuvant treatment of hyperlipidemia and affects both the production and clearance of uric acid, but this The effect is dose-dependent, and if sustained-release preparations are used, the risk of adverse reactions of elevated uric acid can be reduced[5].
05.Fructose
Fructose will promote the decomposition of adenosine triphosphate into adenosine, which is then converted into hypoxanthine, and finally metabolized to uric acid, so whether fructose is used as a solvent during rehydration, or a large amount of Eating fruits high in fructose may increase uric acid levels.
06. Pancreatin preparations
This type of drug is a mixture of various enzymes extracted from the arterial pancreas, including pancreatic lipase, trypsin, pancreatic amylase, etc. Contains a lot of purine ingredients, long-term heavy use will increase the level of uric acid.
07.L-dopa
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 uric acid excretion pathway, 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. Immunosuppressants
include cyclosporine, tacrolimus, etc. Cyclosporine binds to calcium ion-binding protein in the kidney, induces lipid peroxidation in the mitochondria of the kidney cortex, reduces the activity of related enzymes, and directly produces renal toxicity, thereby affecting the secretion and excretion of uric acid in the blood. Tacrolimus causes constriction of renal afferent arterioles in a dose-dependent manner, and some patients may experience renal damage and elevated uric acid levels.
10. Tumor chemotherapeutic drugs
Purine antagonists such as azathioprine and thioguanine have similar structures to endogenous purines in the human body and can be generated under the action of enzymes in the body Uric acid derivatives, which may increase uric acid levels. Methotrexate and its metabolites may be deposited in the renal tubules, resulting in hyperuricemic nephropathy[5].
11.Vitamin C
Vitamin C is an acidic substance. When used in large doses, the content of oxalate in urine will increase by more than 10 times. Thereby causing hyperuricemia[6]. It is worth reminding that taking a small amount of vitamin C (500~1000mg/d) can reduce blood uric acid.
12. Quinolones
such as norfloxacin, levofloxacin, ciprofloxacin, moxifloxacin, etc., the mechanism of causing the increase of uric acid is not clear, and it may be competitive with It is related to inhibiting uric acid excretion, damaging the kidneys and affecting the secretion function. Have you got all the above points? In the clinic, which drug-induced hyperuricemia have you encountered, please comment and tell the editor.
References:
[1]. Chinese Medical Association Endocrinology Branch. Guidelines for 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), China Association for the Promotion of International Exchanges on Healthcare Blood Pressure Branch, Chinese Hypertension Prevention and Treatment Guidelines Revision Committee, et al. Chinese Hypertension Prevention and Treatment Guidelines (2018 revision). Chinese Journal of Cardiovascular Disease, 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]. Aspirin Instructions.[5]. Weeks Jie. Pathogenic drugs and preventive measures of drug-induced hyperuricemia. China Modern Drug Application, 2008(16): 108-110.[6]. Qin Guijun. Drug-induced hyperuricemia. Drug Evaluation, 12（ 7): 2015.19-26.
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