Drug	Dosage	Cost*	Indications	Side effects/comments
Sulfinpyrazone (Anturane)	Begin with 50 mg three times daily, gradually titrating upward until the serum urate level is < 6 mg per dL (355 μmol per L); maximum dosage: 800 mg per day	$16.75; generic: 12.25	Recurrent gout in patients who require antiplatelet therapy; aspirin use may block the effects of probenecid	Uricosuric agent best used in patients on a regular diet who underexcrete uric acid (i.e., < 800 mg of urate in 24 hours [4.76 mmol per day]); inherent antiplatelet activity
Probenecid (Benemid)	Begin with 250 mg twice daily, gradually titrating upward until the serum urate level is < 6 mg per dL (355 μmol per L); maximum dosage: 3 g per day	4.50 to 5.25	Recurrent gout in patients who are allergic or intolerant to allopurinol; may be combined with allopurinol in select patients with resistant hyperuricemia; for use in patients able to maintain oral hydration	Uricosuric agent best used in patients who undersecrete uric acid; creatinine clearance must be > 60 mL per minute (1.00 mL per s); therapeutic effect reversed by high-dose aspirin therapy; avoid concurrent daily aspirin use; contraindicated in patients with a history of urolithiasis; may precipitate gouty attack or renal calculi at start of therapy; rash or gastrointestinal side effects may occur
Allopurinol (Zyloprim)	Begin with 50 to 100 mg daily, gradually titrating upward until the serum urate level is < 6 mg per dL (355 μmol per L); typical dosage: 200 to 300 mg daily	6.50; generic: 2.50 to 3.00	Chronic tophaceous “erosive” gouty arthritis; secondary hyperuricemia related to the use of cytolytics in the treatment of hematologic malignancies; gout complicated by renal disease or renal calculi	Inhibits uric acid synthesis; best for patients who overproduce uric acid (i.e., those who excrete > 800 mg of urate in 24 hours [4.76 mmol per day]); peak effect in reduction of urate synthesis occurs at two weeks; side effects include rash, gastrointestinal symptoms, headache, urticaria and interstitial nephritis; rare, potentially fatal hypersensitivity syndrome may occur (usually in patients with underlying renal insufficency or concurrent thiazide use)