At what level of blood uric acid do you need to take medicine? How long should you take the medicine? What should you pay attention to when taking the medicine?

A friend asked Huazi if he should take medicine for his blood uric acid level of 460μmol/L, and what medicine should he take? Huazi told him that he didn’t need to rush to take medicine for the time being, as his blood uric acid level was not particularly high, and he could just control his diet and drink more water. But he needed to observe more, and if gout symptoms appeared or the blood uric acid level continued to rise, he might need to take medicine.

Uric acid is a normal substance in the human body, which has the physiological functions of maintaining blood pressure, anti-oxidation, and protecting cell DNA. Maintaining a certain level of blood uric acid is beneficial to the human body, but when the blood uric acid is too high, it will cause harm to the human body.

1. What is hyperuricemia?

The human body's blood uric acid level fluctuates to a certain extent. When the blood uric acid levels measured twice on different days are both over 420μmol/L, it is called hyperuricemia .

When the uric acid level in the blood is too high and exceeds its solubility, urate crystals will easily precipitate in the joints or form tophi, inducing an inflammatory response, damaging the surrounding tissues, and causing unbearable severe pain, which is the gout that everyone knows.

If blood uric acid is deposited and crystallized in the kidneys, it will cause acute kidney injury, interstitial nephritis and uric acid stones, causing damage to the kidneys .

2. At what level of blood uric acid do you need to take medicine?

For healthy people who do not have gout symptoms, mildly elevated blood uric acid levels do not require medication. Instead, they only need to control their diet to reduce purine intake, control their weight, and drink plenty of water to promote uric acid excretion. However, if the blood uric acid level exceeds 540 μmol/L, medication is recommended , with the goal of reducing it to below 420 μmol/L.

If there are symptoms of gout, when the blood uric acid level exceeds 480μmol/L, drug treatment is recommended to control the blood uric acid level below 360μmol/L.

For patients with chronic diseases such as "three highs", stroke, coronary heart disease, obesity, renal insufficiency, etc., but without gout symptoms, drug treatment is recommended when the blood uric acid level exceeds 480μmol/L to control the blood uric acid level below 360μmol/L. For patients with gout symptoms, drug treatment is required when the blood uric acid level exceeds 420μmol/L , and the control target is below 300μmol/L.

3. Precautions for different uric acid-lowering drugs

There are three commonly used uric acid-lowering drugs, among which allopurinol and febuxostat are drugs that inhibit uric acid synthesis; benzbromarone is a drug that promotes uric acid excretion. When taking uric acid-lowering drugs, you need to drink a lot of water , which can promote uric acid excretion and prevent kidney stones.

It should be noted that during the acute attack of gout, it is not recommended to use uric acid-lowering drugs , otherwise the blood uric acid level will drop rapidly, causing the surface of tophi to dissolve, releasing uric acid to increase local irritation, and aggravating gout symptoms. Therefore, uric acid-lowering drugs are usually used for asymptomatic hyperuricemia or uric acid-lowering treatment in stable gout patients.

Allopurinol : It is the longest-standing, cheapest, and most widely used uric acid-lowering drug on the market. However, people with positive HLA-B5801 genes may experience severe hypersensitivity reactions when taking allopurinol , and may even develop exfoliative dermatitis with a mortality rate of 20%. The HLA-B5801 positive rate is relatively high in Asian populations, so it is recommended to do an HLA-B5801 gene test before taking the drug. Those who cannot be tested should start taking the drug at the lowest dose.

Febuxostat : It is not recommended for patients with hyperuricemia without gout symptoms. The US FDA indicates that taking Febuxostat may increase the risk of cardiovascular death . It is recommended that patients with cardiovascular disease risk should be evaluated by a doctor before taking the drug.

Benzbromarone : Increases the excretion of uric acid in urine. Drink plenty of water when taking it (more than 3000 ml of water per day). It is contraindicated for people with severe renal insufficiency (glomerular filtration rate less than 20 ml/min) and those with kidney stones . Pay attention to liver function when taking the medicine. Stop the medicine immediately if loss of appetite, nausea, vomiting, or diarrhea occurs.

4. How long should I take uric acid-lowering drugs?

Body weight is positively correlated with blood uric acid levels, so losing weight can reduce blood uric acid levels in obese people . Uric acid is mainly produced by purine metabolism in the human body, and the impact of diet accounts for only about 30%, while 70% is related to personal constitution and genes. If blood uric acid levels cannot reach the standard by losing weight and controlling diet, drug treatment is required.

Uric acid-lowering drugs generally reduce blood uric acid levels steadily within 2 to 4 weeks, so it is recommended to recheck blood uric acid levels after one month of medication and adjust medication according to actual conditions. People with gout symptoms need to take medication for a long time to maintain blood uric acid levels at a low level.

People with asymptomatic hyperuricemia can take intermittent medication , such as taking the medication for one month, taking a one-month break, and then taking the medication for another month to prevent the occurrence of gout.

In summary, people with mild elevated blood uric acid but no gout symptoms can reduce blood uric acid by losing weight and controlling diet. People with blood uric acid levels exceeding 540μmol/L or gout symptoms need to use uric acid-lowering drugs under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.