Lesinurad Brand Name– ZURAMPIC
What is Lesinurad
Lesinurad is a uricosuric agent that is a urate transporter (URAT1) inhibitor. It is used for the adjunct treatment of hyperuricemia associated with gout in patients who have not achieved target serum uric acid levels with a xanthine oxidase inhibitor alone.
Lesinurad product labeling carries a boxed warning regarding the risk of acute renal failure, which is more common when lesinurad was administered as monotherapy and with higher than FDA-approved doses during clinical studies.
Therefore, lesinurad should always be used in combination with a xanthine oxidase inhibitor (XOI) such as allopurinol or febuxostat. Lesinurad should not be used if a patient has persistent renal impairment, as defined by a creatinine clearance of less than 45 mL/minute.
For chronic gout management, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) guidelines recommend urate lowering therapy (ULt) to achieve a target serum uric acid (sUA) level of less than 6 mg/dL to prevent the formation of crystals and to eliminate crystal deposition, thereby dissolving tophi.
A lower target (less than 5 mg/dL) is recommended for patients with severe disease. Allopurinol and febuxostat appear relatively similar as monotherapy in lowering serum urate concentrations and reducing gout flares with long-term (more than 1 year) of use and are generally first-line options.
Treatment guidelines recommend combination therapy (e.g., an XOI plus lesinurad) when treatment goals are not met with initial monotherapy; the use of pegloticase is usually reserved for severe, refractory chronic gout.
Indications
- gout
- gouty arthritis
- hyperuricemia
For the adjunct treatment of hyperuricemia due to gout (gouty arthritis) in patients not achieving target serum uric acid levels with a xanthine oxidase inhibitor alone
Side Effects
- gastroesophageal reflux
- headache
- influenza
- myocardial infarction
- nephrolithiasis
- renal failure (unspecified)
- stroke
Monitoring Parameters
- serum creatinine
- serum uric acid
Contraindications
- breast-feeding
- dialysis
- hepatic disease
- kidney transplant
- Lesch-Nyhan syndrome
- organ transplant
- pregnancy
- renal disease
- renal failure
- renal impairment
- secondary hyperuricemia
- tumor lysis syndrome (TLS)
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