Benzbromarone for Gout
Among the uricosuric drugs used for treatment of gout, Benzbromarone may be the most potent. In as early as 1981, clinical trials have found it very effective and well-tolerated in lowering uric acid in gout patients. Another clinical trial done in 2008 show that Benzbromarone is superior to Allopurinol and Probenecid in lowering uric acid. In fact, it is mainly used in gout patients that have impaired kidney functions that are unable to tolerate Allopurinol, considered first-line treatment for lowering uric acid.
In 2003 however, the drug was withdrawn by US manufacturer Sanofi-Synthelabo after reports of serious liver damaged from taking Benzbromarone. It is still marketed by other drug companies in other countries under the brand names Desuric, Urinorm and Benzbromaron. In UK, Benzbromarone is not widely available but can be obtained by doctors for specific patients who need it. In the Netherlands for example, it is available as Desuric only for gout patients with allergies and known contraindications to Allopurinol.
Benzbromarone for Gout – Recommended Dosage
Where it is available, the recommended dosage of Benzbromarone for gout patients is 50-200mg daily. A lower dosage of 20mg daily has also been used in combination with Allopurinol. It is particularly given to patients with severe to moderate kidney impairment and patients with uric acid renal calculi as long as the uric acid excretion rate in the urine is not greater than 700 mg per 24 hours. Patients taking it are advised to have increased fluid intake with liver functions monitored. Aspirin and other salicylates may affect its efficacy.
Benzbromarone is not used for treatment of acute gout. It is recommended that a non-steriodal anti-inflammatory drug (NSAID) or Colchicine be given first to make an acute gout attack subside prior to administering Benzbromarone.
Benzbromarone – Side effects
Benzbromarone has been reported to cause adverse gastrointestinal side-effects such as diarrhea. As with any uric acid lowering drugs, it may trigger an acute gout attack or worsen a current one. But its most fatal side-effect is hepatoxicity or liver damage. There is limited literature on the exact mechanism by which Benzbromarone damages the liver. The studies available point to accumulation in the liver of Benzbromarone and its metabolic products as the culprit of liver damage. There are also reported cases of Benzbromarone-induced eosinophilic pneumonia and pulmonary alveolar hemorrhage.
For patients with allergic reactions to Allopurinol or have contraindications to its usage, Benzbromarone may be a viable alternative. What is important is to exhaust all available treatments and if a particular treatment with possible adverse side-effects is the only option, the benefits should outweigh the risks. You and your doctor will have to decide which option is best for you.