Mika Note

秋水仙素 Colchicine (0.5MG)

使用劑量

Flare treatment (Colcrys):

Initial: 1.2 mg at the first sign of flare, followed in 1 hour with a single dose of 0.6 mg (maximum: 1.8 mg within 1 hour). Patients receiving prophylaxis therapy may receive treatment dosing; wait 12 hours before resuming prophylaxis dose. Note: Current FDA-approved dose for gout flare is substantially lower than what has been historically used clinically. Doses larger than the currently recommended dosage for gout flare have not been proven to be more effective.

Prophylaxis (Colcrys and Mitigare):

0.6 mg once or twice daily; maximum: 1.2 mg daily. The duration of prophylaxis is 6 months or 3 months (patients without tophi) to 6 months (≥1 tophi) after achieving target serum uric acid levels (ACR guidelines [Khanna, 2012]).

腎功能不佳之劑量調整

Gout prophylaxis:

CrCl 30 to 80 mL/minute:

Colcrys: Dosage adjustment not required; monitor closely for adverse effects.

Mitigare: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

CrCl <30 mL/minute:

Colcrys: Initial dose: 0.3 mg daily; use caution if dose titrated; monitor for adverse effects.

Mitigare: There is no specific dosage adjustment provided in the manufacturer’s labeling; dosage reduction or alternative therapy should be considered

Dialysis:

Colcrys: 0.3 mg twice weekly; monitor closely for adverse effects.

Mitigare: There are no dosage adjustments provided in the manufacturer’s labeling; monitor closely.

Gout flare treatment: Colcrys: Note: Treatment of gout flares is not recommended in patients with renal impairment who are receiving colchicine for prophylaxis.

CrCl 30 to 80 mL/minute: Dosage adjustment not required; monitor closely for adverse effects.

CrCl <30 mL/minute: Dosage reduction not required but may be considered; treatment course should not be repeated more frequently than every 14 days.

Dialysis: 0.6 mg as a single dose; treatment course should not be repeated more frequently than every 14 days. Not removed by dialysis.

Hemodialysis: Avoid chronic use of colchicine.

肝臟功能不佳之劑量調整

Gout prophylaxis:

Mild to moderate impairment:

Colcrys: Dosage adjustment not required; monitor closely for adverse effects.

Mitigare: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Severe impairment: Colcrys and Mitigare: There is no specific dosage adjustment provided in the manufacturer’s labeling; dosage adjustment should be considered.

Gout flare treatment: Note: Treatment of gout flares is not recommended in patients with hepatic impairment who are receiving colchicine for prophylaxis.

Mild to moderate impairment: Dosage adjustment not required; monitor closely for adverse effects.

Severe impairment: Dosage reduction not required but may be considered; treatment course should not be repeated more frequently than every 14 days.

異嘌呤醇 Allopurinol (100MG)

使用劑量

< Oral doses >300 mg should be given in divided doses.>

Manufacturer’s labeling: 

Initial: 100 mg once daily; increase at weekly intervals in increments of 100 mg/day as needed to achieve desired serum uric acid level. Usual dosage range: 200 to 300 mg/day in mild gout; 400 to 600 mg/day in moderate to severe tophaceous gout. Maximum daily dose: 800 mg/day.

Alternative dosing (off-label): 

Initial: 100 mg/day, increasing the dose gradually in increments of 100 mg/day every 2 to 5 weeks as needed to achieve desired serum uric acid level of ≤6 mg/dL (ACR guidelines [Khanna, 2012]; EULAR guidelines [Zhang, 2006]; McGill, 2010). Some patients may require therapy targeted at a serum uric acid level <5 mg/dL to control symptoms. Allopurinol may be initiated during an acute gout attack so long as antiinflammatory therapy has been initiated as well (ACR guidelines [Khanna, 2012]).

腎功能不佳之劑量調整

Manufacturer’s labeling: Oral, IV: Lower doses are required in renal impairment due to potential for accumulation of allopurinol and metabolites.

CrCl 10 to 20 mL/minute: 200 mg daily

CrCl 3 to 10 mL/minute: ≤100 mg daily

CrCl <3 mL/minute: ≤100 mg/dose at extended intervals

肝臟功能不佳之劑量調整

There are no dosage adjustments provided in the U.S. manufacturer’s labeling.

The Canadian labeling suggests that a dose reduction is necessary but does not provide specific dosing recommendations.

(優利康) Benzbromarone (Ericon 50MG)

使用劑量

50mg-150mg. devided 1-3 times

本品並無肝腎功能異常時之劑量調整標準。知其主要經肝臟之去鹵素化作用(dehalogenation)，形成bromobenzarone及benzarone，故肝臟功能異常者須斟酌調整劑量。

本品曾有猛暴性肝炎的案例，故初使用的前六個月內及長期使用時，應定期進行肝功能檢查。

(福避痛) Febuxostat  (Feburic 80MG)

<Not recommended for treatment of asymptomatic hyperuricemia.>

健保給付規定

2.11.1.Febuxostat（如Feburic）：（101/4/1、103/3/1）
限慢性痛風患者之高尿酸血症使用，且符合以下條件之一：
1.曾使用過降尿酸藥物benzbromarone治療反應不佳，尿酸值仍高於6.0 mg/dL。（103/3/1）
2.患有慢性腎臟病 (eGFR＜45 mL/min/1.73m2或serum creatinine≧1.5mg/dL)或肝硬化之痛風病人。（103/3/1）

使用劑量

labeling: Initial: 40 mg once daily; may increase to 80 mg once daily in patients who do not achieve a serum uric acid level <6 mg/dL after 2 weeks. The dose may be increased further to 120 mg once daily if clinically indicated (ACR guidelines [Khanna, 2012]).

腎臟功能不佳之劑量調整

Mild-to-moderate impairment (CrCl 30 to 89 mL/minute): No dosage adjustment necessary

Severe impairment (CrCl <30 mL/minute): There are no dosage adjustments provided in the manufacturer’s labeling (insufficient data); use caution (use not recommended in the Canadian labeling)

Dialysis: There are no dosage adjustments provided in the manufacturer’s labeling; has not been studied (use not recommended in the Canadian labeling)

肝臟功能不佳之劑量調整

Mild-to-moderate impairment (Child-Pugh class A or B): No dosage adjustment necessary

Severe impairment (Child-Pugh class C): There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use caution (use not recommended in the Canadian labeling)