From the Guidelines
Yes, Lasix (furosemide) can induce gout, as it is a loop diuretic that increases uric acid levels in the blood by reducing uric acid excretion in the kidneys, which can trigger gout attacks in susceptible individuals 1.
Key Points to Consider
- Furosemide works by inhibiting sodium reabsorption in the kidneys, which inadvertently affects uric acid transport and leads to hyperuricemia (elevated uric acid levels) 1.
- The risk of developing gout is dose-dependent, with higher doses and longer treatment durations increasing the likelihood of gout flares.
- Patients with pre-existing hyperuricemia or a history of gout are particularly vulnerable.
- If possible, stopping the diuretic or switching to an alternative drug regimen that does not contain a diuretic may be considered, especially for patients with hypertension, where losartan can be an alternative due to its uricosuric effects 1.
Management and Prevention
- If you're taking Lasix and experience symptoms of gout, such as sudden, severe joint pain (often in the big toe), redness, swelling, and tenderness, contact your healthcare provider.
- They may consider alternative medications, adjust your Lasix dosage, or prescribe medications to prevent gout attacks, such as allopurinol or febuxostat, which lower uric acid levels.
- Staying well-hydrated (unless fluid restricted) and limiting alcohol and purine-rich foods can help reduce the risk of gout while taking furosemide.
Clinical Considerations
- For patients with gout and hypertension, an antihypertensive regimen that does not contain a thiazide should be considered, with losartan being a potential option due to its uricosuric action 1.
- The lipid-lowering agent fenofibrate has also shown uricosuric and serum urate-lowering effects, making it another potential consideration for patients with gout and hyperlipidemia 1.
From the FDA Drug Label
Asymptomatic hyperuricemia can occur and gout may rarely be precipitated.
Yes, Lasix (furosemide) can induce gout, although this is a rare occurrence. According to the drug label, asymptomatic hyperuricemia can occur, and gout may rarely be precipitated 2. It is essential to monitor patients for signs of gout, especially those with a history of the condition.
- Key points:
- Asymptomatic hyperuricemia can occur
- Gout may rarely be precipitated
- Monitoring is essential, especially for patients with a history of gout 2
From the Research
Lasix and Gout Induction
- Lasix, also known as furosemide, is a diuretic that can increase the risk of gout, as it can raise serum urate levels 3.
- A study published in 2012 found that furosemide increases plasma oxypurinol without lowering serum urate, which can lead to gout 4.
- Another study from 1992 found that diuretic-induced gout occurs in patients with additional causes of hyperuricaemia, such as impaired renal function 3.
Risk Factors for Gout
- Diuretic use, including Lasix, is a known risk factor for gout 5, 6.
- Other risk factors for gout include male sex, obesity, hypertension, alcohol intake, and a diet rich in meat and seafood 5.
- Chronic kidney disease and impaired renal function can also increase the risk of gout 3, 6.
Urate-Lowering Therapies
- Urate-lowering therapies, such as allopurinol and febuxostat, can help prevent gout flare-ups 5, 7.
- However, the use of diuretics like Lasix can affect the efficacy of these therapies and increase the risk of gout 4, 6.
- A study published in 2021 found that lesinurad in combination with febuxostat or allopurinol can be effective in urate lowering, but may have a high risk of adverse events 7.