Probenecid

Label: 'Therapy with probenecid should not be started until an acute gouty attack has subsided. However, if an acute attack is precipitated during therapy, probenecid may be continued without changing the dosage, and full therapeutic dosage of colchicine or other appropriate therapy should be given to control the acute attack.' 'The recommended adult dosage is 250 mg (1/2 tablet of probenecid) twice a day for one week, followed by 500 mg (1 tablet) twice a day thereafter.' Titration: 'Some degree of renal impairment may be present in patients with gout. A daily dosage of 1000 mg may be adequate. However, if necessary, the daily dosage may be increased by 500 mg increments every 4 weeks within tolerance (and usually not above 2000 mg per day) if symptoms of gouty arthritis are not controlled or the 24 hour uric acid excretion is not above 700 mg.' Gastric intolerance may indicate overdosage and may be corrected by decreasing the dosage. Urine alkalinisation: as uric acid crystallises out of an acid urine, a liberal fluid intake is recommended, as well as sufficient sodium bicarbonate (3 to 7.5 g daily) or potassium citrate (7.5 g daily) to maintain an alkaline urine, until the serum urate level returns to normal limits and tophaceous deposits disappear. Maintenance: continue at the dosage that maintains normal serum urate levels; when acute attacks have been absent for 6 months or more and serum urate levels remain within normal limits, the daily dosage may be decreased by 500 mg every 6 months, but not to the point where serum urate levels tend to rise. The label's other indication (adjuvant to penicillin/beta-lactam therapy, adults 2000 mg daily in divided doses) is a different use and is not this page's dose. No UK SPC for probenecid is listed on eMC — this dose is from US prescribing information (Probenecid tablets, RemedyRepack) and must be verified against UK practice.