Dose of steroids in gout

G’day Andy – Be aware that the fructose from fruits is notorious for purines and concerting to uric acid. Plus, the fructose is converted by your liver to triglycerides in your blood and contributed to depositing fat around the midsection. Just thought you should know. Season ripe fruits usually ripen just before Autumn when the last of fat depositing is needed before the hard to find food time of Winter. Hence, a good reason NOT to eat fruit year round. Since food is not hard to find these days and season ripen fruits are available year round, best to avoid them most of the time.

Allopurinol is a well tolerated, inexpensive, and commonly used uric acid lowering agent. Allopurinol can be started at doses as low as 100 mg daily (100 mg qod if creatinine clearance < 10 cc/min) and titrated by 100 mg every 10-14 days to achieve a serum uric acid level of 4-5 mg/dl.  Liver tests, blood counts, and renal function and should be monitored while on therapy. Toxicites include rash, hepatoxicity, bone marrow suppression and severe hypersensitivity reactions. Medication interactions can occur with allopurinol, warfarin, and theophylline and levels should be monitored. Allopurinol should be avoided in patients on azathiprine, 6-mercaptopurine and cyclophosphamide because of risk for bone marrow toxicity.

"May 2016, white male 51 yrs old, first gout attack. I was lifting heavy about 2 weeks ago and I over did red meat, chicken, salmon, two protein shakes per day at 30 grams each, aspirin almost daily and a 5 hour energy drink, junk food in there for good measure. Drink instant coffee excessively daily Did not like to drink water so likely became hydrated as well. I feel I brought this on with my eating habits but blood test came back uric acid which was within normal range. I in total pain and missed 2 weeks of work. Doctor put me on Indomethacin after weeks of Advil, water, cherries, cherry juice, no red meat or alcohol, etc with no relief. Felt relief first hour. Did get a little dizzy but pain is almost gone after 1st pill."

Dosing should be individualized based on disease and patient response :

Initial dose: 5 to 60 mg orally per day
Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Comments :
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 to 8 AM) when dosing.
-The delayed-release tablets act similarly to the immediate-release tablets except for the timing of drug release; active drug is released from the delayed-release tablets approximately 4 to 6 hours after intake.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy as appropriate, such as for the treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Dose of steroids in gout

dose of steroids in gout

Dosing should be individualized based on disease and patient response :

Initial dose: 5 to 60 mg orally per day
Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Comments :
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 to 8 AM) when dosing.
-The delayed-release tablets act similarly to the immediate-release tablets except for the timing of drug release; active drug is released from the delayed-release tablets approximately 4 to 6 hours after intake.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy as appropriate, such as for the treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

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