What is the recommendation for prophylactic medication in a 51-year-old male with a history of gout, currently asymptomatic, with elevated uric acid levels (hyperuricemia), and not currently on medication, prior to traveling?

From the Guidelines

For a 51-year-old male with a history of gout and elevated uric acid of 8.5 mg/dL, prophylactic medication with colchicine 0.5-1 mg/day is recommended during the initiation of urate-lowering therapy (ULT) to prevent gout flares, especially since he is planning to travel and will be at higher risk of flare triggers 1. When considering ULT, it's essential to discuss the risks and benefits with the patient, as well as the importance of lifestyle modifications, such as weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise 1. Key points to consider for this patient include:

• Starting ULT with a low dose and titrating upwards to achieve a serum uric acid (SUA) level <6 mg/dL (360 mmol/L) 1
• Monitoring SUA levels and adjusting ULT as needed to maintain the target level 1
• Avoiding triggers for gout flares, such as alcohol and high-purine foods, during travel 1
• Ensuring adequate hydration during travel to help prevent gout flares 1 It's crucial to note that the patient's high uric acid level (>8.0 mg/dL) and age (<40 years is not applicable in this case, but the high uric acid level is a consideration) indicate a need for ULT, and prophylactic medication with colchicine can help prevent gout flares during the initial treatment period 1.

From the FDA Drug Label

The recommended dosage of Colchicine Tablets, USP for prophylaxis of gout flares for adults and adolescents older than 16 years of age is 0.6 mg once or twice daily. The maximum recommended dose for prophylaxis of gout flares is 1.2 mg/day. Prophylactic therapy may be beneficial for at least the first six months of uric acid-lowering therapy.

For a 51-year-old male with a history of gout and recent uric acid level of 8.5, not currently symptomatic and not on medication, prophylactic colchicine may be considered to prevent gout flares, especially if uric acid-lowering therapy is initiated.

• The recommended dose for prophylaxis of gout flares is 0.6 mg once or twice daily, with a maximum recommended dose of 1.2 mg/day 2. Since the patient is getting ready to travel and is not currently on medication, it is essential to consider the potential risk of gout flares and the benefits of prophylactic therapy. However, the decision to start prophylactic colchicine should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history. 2

From the Research

Medication Prophylaxis for Gout

The patient has a history of gout with a recent uric acid level of 8.5, but is not currently symptomatic and not on medication. Considering the patient's upcoming travel, medication prophylaxis may be recommended to prevent gout flares.

Urate-Lowering Therapies

• Allopurinol and febuxostat are commonly used urate-lowering therapies to prevent gout flares, as mentioned in 3 and 4.
• However, febuxostat has received a U.S. FDA black box warning for cardiovascular safety, as noted in 4.
• Uricosuric agents, such as probenecid, sulfinpyrazone, and benzbromarone, can be used as adjuncts to urate-lowering therapies, as mentioned in 3.

Prophylactic Medication for Travel

• There is no specific mention of prophylactic medication for travel in the provided studies.
• However, considering the patient's history of gout and upcoming travel, it may be recommended to start urate-lowering therapy to prevent gout flares, as indicated in 5.

Indications for Long-Term Urate-Lowering Therapy

• The patient's uric acid level of 8.5 and history of gout may indicate the need for long-term urate-lowering therapy, as mentioned in 5.
• However, the decision to start medication should be based on individual patient factors, such as comorbidities and patient preference, as noted in 3 and 4.