From the Guidelines
High uric acid levels should be managed with a combination of lifestyle modifications and medications, prioritizing allopurinol as the first-line treatment, starting at a low dose of 100mg daily and increasing as needed, as recommended by the most recent and highest quality study 1. To lower uric acid levels, it is essential to limit purine-rich foods like red meat, organ meats, seafood, and alcohol (especially beer), and focus on a diet rich in fruits, vegetables, whole grains, and low-fat dairy. Staying well-hydrated by drinking 8-10 glasses of water daily can also help flush excess uric acid through the kidneys. Medications like allopurinol or febuxostat can effectively reduce uric acid production. For acute gout attacks, anti-inflammatory medications such as colchicine, NSAIDs like naproxen, or corticosteroids may be prescribed. Weight loss if overweight and regular exercise can also help manage uric acid levels. These approaches work by either reducing uric acid production in the body or increasing its elimination through the kidneys, addressing the fundamental imbalance that causes hyperuricemia. Key considerations in managing high uric acid levels include:
- Identifying and addressing specific risk factors, such as chronic kidney disease, overweight, and excess alcohol consumption 1
- Tailoring treatment to the individual's clinical phase, such as acute or chronic gout, and general risk factors, such as age, sex, and comorbidity 1
- Monitoring and adjusting treatment as needed to achieve optimal uric acid levels and prevent complications 1
From the FDA Drug Label
It is an inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine and of xanthine to uric acid, the end product of purine metabolism in man. The etiology of this hyperuricemia is the overproduction of uric acid in relation to the patient's ability to excrete it Administration of allopurinol tablets generally results in a fall in both serum and urinary uric acid within 2 to 3 days. Allopurinol tablets reduce both the serum and urinary uric acid levels by inhibiting the formation of uric acid
High uric acid levels can be reduced by administering allopurinol tablets, which inhibit the formation of uric acid by blocking the enzyme xanthine oxidase. This results in a fall in both serum and urinary uric acid levels within 2 to 3 days 2. The degree of this decrease can be manipulated almost at will since it is dose-dependent.
From the Research
High Uric Acid Overview
- High uric acid levels are associated with various health issues, including hypertension, gout, and kidney disease 3, 4, 5, 6, 7
- Uric acid levels are higher in humans than in other mammals, and it can increase salt sensitivity, fat storage, and lipogenesis 3
Causes and Risk Factors
- Maternal hyperuricemia during pregnancy and hyperuricemia early in life are independent risk factors for hypertension 3
- Genetic polymorphism is potentially involved in the activity of xanthine oxidoreductase, but further studies are needed 3
- Western diet, insulin resistance, and renal dysfunction can contribute to hyperuricemia, affecting one out of five adults 3
Treatment and Management
- Xanthine oxidase inhibition consistently decreases blood pressure in younger hypertensive patients, albeit modestly 3
- Lifestyle changes can help maintain uric acid levels within the normal range in young (pre)hypertensive individuals or normotensives with a family history of hypertension, metabolic disorders, or obesity 3
- Antihypertensive medications that increase uric acid levels should be avoided 3
- Febuxostat and allopurinol are used to treat hyperuricemia, with febuxostat being more effective in reducing serum uric acid levels in patients with chronic kidney disease 5, 6, 7
- Benzbromarone therapy is associated with a reduced risk of progression to dialysis compared to allopurinol 7
Renal Outcomes
- Febuxostat may suppress the progressive decline in renal function in patients with chronic kidney disease 5
- There were no significant differences in the mean eGFR changes over time between the febuxostat and allopurinol groups or in the risk of eGFR decline ≥30% of baseline 6
- Febuxostat and benzbromarone may be more effective in reducing the risk of progression to dialysis and in lowering SUA levels in CKD populations 7