New Drug Reviews
Lesinurad (Zurampic) for Gout
Am Fam Physician. 2018 Mar 15;97(6):374-375.
Lesinurad (Zurampic) is a uricosuric agent labeled for the treatment of hyperuricemia that is associated with gout. It should be used in patients who are already taking appropriate doses of a xanthine oxidase inhibitor such as allopurinol, but who have not yet reached target levels of serum uric acid.1
200 mg once daily
200 mg once daily
Lesinurad can cause acute renal failure if taken without a xanthine oxidase inhibitor, at a higher dose than recommended, or by patients with moderately reduced renal function (creatinine clearance less than 45 mL per minute per 1.73 m2 [0.75 mL per second per m2]).1 Renal function should be monitored in all patients, especially those with a creatinine clearance less than 60 mL per minute per 1.73 m2 (1.00 mL per second per m2) or who have increased levels of serum creatinine. Lesinurad should be discontinued in patients with symptoms of uric acid nephropathy or serum creatinine elevations 1.5 to 2 times the pretreatment value.1 In premarketing research, major adverse cardiovascular events occurred at a slightly higher rate in patients taking lesinurad vs. those taking placebo, especially at higher-than-recommended doses.1
Lesinurad is metabolized in the liver by the cytochrome P450 (CYP450) 2C9 enzyme system. It may affect the blood levels of other medications metabolized by this system, and it may be affected by these other medications, although the degree to which these interactions are clinically relevant is unknown. Lesinurad may reduce the reliability of oral, injectable, transdermal, and implantable hormonal contraceptives; therefore, women taking lesinurad should use additional methods of contraception. Daily dosages of aspirin greater than 325 mg may increase uric acid levels, reducing the effect of uric acid treatment.1 Safety has not been established in pregnant or breas
Referencesshow all references
1. DailyMed. Drug label information: Zurampic—lesinurad tablet, film coated. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=92d614a3-760d-492c-930d-22f91ff016b1. Accessed March 15, 2017....
2. U.S. Food and Drug Administration. FDA approves Zurampic to treat high blood uric acid levels associated with gout. December 22, 2015. https://wayback.archive-it.org/7993/20170111160731/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm478791.htm. Accessed March 31, 2017.
3. Bardin T, Keenan RT, Khanna PP, et al. Lesinurad in combination with allopurinol: a randomised, double-blind, placebo-controlled study in patients with gout with inadequate response to standard of care (the multinational CLEAR 2 study). Ann Rheum Dis. 2017;76(5):811–820.
4. Saag KG, Fitz-Patrick D, Kopicko J, et al. Lesinurad combined with allopurinol: a randomized, double-blind, placebo-controlled study in gout patients with an inadequate response to standard-of-care allopurinol (a US-based study). Arthritis Rheumatol. 2017;69(1):203–212.
STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.
This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, Contributing Editor.
A collection of STEPS published in AFP is available at http://www.aafp.org/afp/steps.
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