Does spironolactone carry less risk of causing gout flare-up compared to triamterene/hydrochlorothiazide (Maxzide)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 29, 2025 • View editorial policy

From the Guidelines

Spironolactone is generally considered to carry less risk of causing gout flare-ups compared to Maxzide due to its minimal effect on uric acid levels. When considering the management of patients with gout, it's crucial to understand the impact of different medications on uric acid levels and the risk of gout flares. The American College of Physicians guideline on the management of acute and recurrent gout 1 emphasizes the importance of managing urate levels to prevent gout flares, but it does not directly compare spironolactone and Maxzide. However, the mechanism of action of these drugs provides insight into their potential effects on gout.

  • Spironolactone, a potassium-sparing diuretic, blocks aldosterone receptors and has a minimal effect on uric acid levels, making it a preferable option for patients with gout.
  • Maxzide, which contains hydrochlorothiazide, a thiazide diuretic, can increase serum uric acid levels by reducing uric acid excretion in the kidneys, potentially precipitating gout attacks in susceptible individuals. Key considerations in choosing between these medications include the patient's history of gout, hyperuricemia, and kidney function, as well as the potential side effects of each medication, such as hyperkalemia with spironolactone. Given the potential of thiazide diuretics like hydrochlorothiazide (found in Maxzide) to increase uric acid levels and precipitate gout attacks, spironolactone would be a preferable option for patients at risk of gout flare-ups, taking into account its own side effect profile and the need for monitoring, especially in patients with kidney disease or those on other potassium-sparing medications or supplements 1.

From the Research

Comparison of Spironolactone and Maxzide

  • Spironolactone and Maxzide are both used to treat hypertension, but they have different effects on uric acid levels.
  • According to a study published in 1983 2, spironolactone was found to decrease uric acid levels in the blood after 6 months of treatment.
  • In contrast, thiazide diuretics, which are a component of Maxzide, have been shown to increase uric acid levels and contribute to the development of gout 3.
  • A study published in 2009 4 found that spironolactone did not significantly change serum uric acid levels, whereas another study published in 1988 5 found that spironolactone increased uric acid levels, but to a lesser extent than thiazide diuretics.
  • Overall, the evidence suggests that spironolactone may carry less risk of causing gout flare-ups compared to Maxzide, but more research is needed to confirm this.

Mechanism of Action

  • Spironolactone is a mineralocorticoid receptor blocker that works by blocking the action of aldosterone, a hormone that regulates electrolyte balance in the body.
  • Thiazide diuretics, on the other hand, work by increasing the excretion of sodium and water in the urine, which can lead to an increase in uric acid levels.
  • The different mechanisms of action of spironolactone and thiazide diuretics may contribute to their differing effects on uric acid levels and gout risk.

Clinical Implications

  • Patients with hypertension who are at risk of gout may benefit from treatment with spironolactone instead of Maxzide.
  • However, more research is needed to fully understand the effects of spironolactone and Maxzide on uric acid levels and gout risk, and to determine the best treatment options for individual patients 6, 3, 2, 4, 5.

References

3
Research

Drug-induced hyperuricaemia and gout.

Rheumatology (Oxford, England), 2017

6
Research

Gout: Rapid Evidence Review.

American family physician, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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