Lesinurad Allopurinol

Lesinurad Allopurinol Brand Name– DUZALLO

What is Lesinurad Allopurinol

Lesinurad, a uricosuric agent that is an urate transporter (URAT1) inhibitor, and allopurinol, a xanthine oxidase inhibitor (XOI), are used in combination to treat hyperuricemia due to gout in patients who have not achieved target serum uric acid levels with a medically appropriate daily dose of allopurinol alone.

The product labeling carries a boxed warning regarding the risk of acute renal failure; this product should not be used if a patient has persistent renal impairment, as defined by a creatinine clearance of less than 45 mL/minute. Therapy requires close monitoring for rash or other serious hypersensitivity reactions to allopurinol.

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.

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 treatment of hyperuricemia due to gout (gouty arthritis) in patients not achieving target serum uric acid levels with allopurinol alone

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. alopecia
  4. amblyopia
  5. amnesia
  6. anemia
  7. anorexia
  8. aplastic anemia
  9. arthralgia
  10. asthenia
  11. azotemia
  12. bradycardia
  13. bronchospasm
  14. bullous rash
  15. cataracts
  16. confusion
  17. conjunctivitis
  18. depression
  19. diarrhea
  20. dizziness
  21. drowsiness
  22. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  23. dysgeusia
  24. dyspepsia
  25. ecchymosis
  26. elevated hepatic enzymes
  27. eosinophilia
  28. epistaxis
  29. erythema multiforme
  30. exfoliative dermatitis
  31. fever
  32. gastritis
  33. gastroesophageal reflux
  34. GI bleeding
  35. gynecomastia
  36. headache
  37. hematuria
  38. hemolytic anemia
  39. hepatic necrosis
  40. hepatitis
  41. hepatomegaly
  42. hyperbilirubinemia
  43. hypercalcemia
  44. hyperhidrosis
  45. hyperlipidemia
  46. impotence (erectile dysfunction)
  47. influenza
  48. insomnia
  49. iritis
  50. jaundice
  51. leukocytosis
  52. leukopenia
  53. libido decrease
  54. lichen planus-like eruption
  55. lymphadenopathy
  56. lymphocytosis
  57. maculopapular rash
  58. malaise
  59. myocardial infarction
  60. myopathy
  61. nausea
  62. nephrolithiasis
  63. neuritis
  64. onycholysis
  65. optic neuritis
  66. pancreatitis
  67. pancytopenia
  68. paresthesias
  69. pericarditis
  70. peripheral neuropathy
  71. peripheral vasodilation
  72. pharyngitis
  73. proteinuria
  74. pruritus
  75. purpura
  76. rash
  77. renal failure (unspecified)
  78. rhinitis
  79. sialadenitis
  80. Stevens-Johnson syndrome
  81. stomatitis
  82. stroke
  83. thrombocytopenia
  84. tinnitus
  85. toxic epidermal necrolysis
  86. urticaria
  87. vasculitis
  88. vomiting

Monitoring Parameters

  • CBC with differential
  • LFTs
  • serum creatinine/BUN
  • serum uric acid

Contraindications

  • anticoagulant therapy
  • bone marrow suppression
  • breast-feeding
  • children
  • dialysis
  • driving or operating machinery
  • hepatic disease
  • hepatotoxicity
  • infants
  • kidney transplant
  • Lesch-Nyhan syndrome
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • serious rash
  • tumor lysis syndrome (TLS)

Interactions

  • Abiraterone
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Alfentanil
  • Alfuzosin
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  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
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  • Aluminum Hydroxide; Magnesium Carbonate
  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Aluminum Hydroxide; Magnesium Trisilicate
  • Amiodarone
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amobarbital
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  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amoxicillin; Clavulanic Acid
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  • Artemether; Lumefantrine
  • Aspirin, ASA
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  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
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  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
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