What medications in a cancer patient can cause hyperuricemia (gout)?

From the Guidelines

Cancer patients are at risk of developing hyperuricemia, a condition that can lead to gout, due to various medications used in their treatment, including chemotherapy drugs like cisplatin, cyclophosphamide, and methotrexate, as well as diuretics and certain targeted therapies. These medications can increase uric acid levels by causing rapid cell death, reducing uric acid excretion, or impairing its metabolism 1.

Medications that Contribute to Hyperuricemia

• Chemotherapy drugs: cisplatin, cyclophosphamide, and methotrexate can cause rapid cell death, leading to the release of purines that metabolize to uric acid 1
• Diuretics: furosemide and hydrochlorothiazide can reduce uric acid excretion by the kidneys 1
• Targeted therapies and immunotherapies: may contribute to hyperuricemia, although the exact mechanisms are not fully understood 1
• Low-dose aspirin: can impair uric acid excretion, increasing the risk of hyperuricemia 1
• Corticosteroids: like prednisone, can paradoxically increase uric acid levels during dose tapering, despite being used to treat gout in some cases 1

Preventive Measures

• Adequate hydration is crucial in preventing hyperuricemia, as it helps to dilute uric acid in the blood and promote its excretion through the kidneys 1
• Allopurinol prophylaxis during chemotherapy initiation can help reduce the risk of hyperuricemia by inhibiting the formation of uric acid 1
• Monitoring uric acid levels, especially in patients with pre-existing risk factors for gout, is essential for early detection and management of hyperuricemia 1

Management of Hyperuricemia

• Rasburicase, a recombinant urate oxidase enzyme, can be used to rapidly reduce uric acid levels in patients with hyperuricemia, especially those with renal impairment 1
• Allopurinol can be used to prevent the formation of uric acid, but its use may be limited by its slow onset of action and potential side effects 1 By understanding the medications that contribute to hyperuricemia and taking preventive measures, healthcare providers can help reduce the risk of gout in cancer patients and improve their overall quality of life.

From the Research

Medications Causing Hyperuricemia in Cancer Patients

• The following medications can cause hyperuricemia (gout) in cancer patients:
  • Diuretics 2
  • β-blockers 2
  • Insulin 2
  • Pyrazinamide 2
  • Ethambutol 2
  • Calcineurin inhibitors 2
  • Low-dose aspirin 2
  • Testosterone 2
  • Lactate 2
• Certain cancer treatments, such as chemotherapy and radiation therapy, can also increase uric acid levels, leading to hyperuricemia 3, 4, 5, 6
• It is essential to note that the relationship between gout medications and cancer risk is still being researched, and some studies suggest that gout medications may increase the risk of certain types of cancer 4, 6

Urate-Lowering Therapies

• Urate-lowering therapies (ULTs) are used to treat hyperuricemia and gout, and include:
  • Xanthine oxidoreductase inhibitors 3
  • Uricosurics, such as benzbromarone, dotinurad, and probenecid 3
  • Uricases, such as rasburicase and pegloticase 3
• These therapies aim to reduce serum urate levels and prevent gout attacks 3, 5

Off-Label Effects of Commonly Used Medications

• Some commonly used medications can have off-label effects on serum urate levels, including:
  • Angiotensin II receptor blockers, which can lower serum urate levels 2
  • Calcium channel blockers, which can lower serum urate levels 2
  • High-dose aspirin and salicylates, which can lower serum urate levels 2
  • Some nonsalicylate nonsteroidal anti-inflammatory drugs, which can lower serum urate levels 2
  • Angiotensin-converting enzyme inhibitors, which can lower serum urate levels 2
  • Sodium-glucose cotransporter 2 inhibitors, which can lower serum urate levels 2
  • Statins, which can lower serum urate levels 2
  • Fenofibrate, which can lower serum urate levels 2