•
Blood disorders including haemolytic anaemia and leukopenia
INTERACTIONS • 6-Mercaptopurine (increased risk of toxicity)
CLINICAL NOTE • A prophylactic NSAID (which is not aspirin) or colchicine is usually co-administered • Check if patient who presents with gout is prescribed a thiazide diuretic before prescribing
URICOSURIC AGENTS: PROBENECID MECHANISM OF ACTION • •
Increase uric acid secretion by inhibiting reabsorption in the proximal tubule Mechanism of action is unclear but it lowers plasma urate, dissolves urate crystals and reverses crystal deposition in synovial joints
INDICATIONS •
Tumour lysis syndrome (chemotherapy) to prevent kidney damage
DISEASE MODIFYING ANTIRHEUMATIC DRUGS (DMARD’S) HYDROXYCHLOROQUINE & SULPHASALAZINE MECHANISM OF ACTION • MOA unclear but has a long term depressive effect on inflammation by improving symptoms and reducing disease activity. • Hydroxychloroquine interferes with leukocyte function inhibiting IL-1. • Also has inhibitory effect on the DNA synthesis at high doses. • Sulphasalazine is the most commonly used DMARD in the U.K.
INDICATIONS • Suppressive treatment and treatment of acute attacks of malaria. • Treatment of discoid and systemic lupus erythematosus, and rheumatoid arthritis.
CLINICAL NOTE • Hydroxychloroquine is reserved for cases where other treatments have failed. • Low toxicity. • Acute haemolysis may be caused in those with G6PDH deficiency.
GOLD AND PENICILLAMINE
