Sulfinpyrazone

INTRODUCTION

Indications

Management (long-term) of gout.

Action

Decreases serum uric acid levels by decreasing renal reabsorption and subsequently increasing urinary excretion. Therapeutic Effects: Reduction in serum uric acid levels.

Adverse Reactions/Side Effects

GI: GI BLEEDING, nausea, vomiting, abdominal pain. Derm: rash. Hemat: blood dyscrasias. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

• Assess pain and other variables (range of motion, gait, other functional activities) to document whether this drug is successful in helping manage the patient's pain and decreasing impairments related to gout.

• Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

Interventions

• Implement appropriate physical agents, therapeutic exercises, orthoses, and assistive devices to reduce gout pain and compliment the effects of drug therapy.

Patient/Client-Related Instruction

• Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged fever, skin rash, or GI problems (nausea, vomiting, abdominal pain).

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Distribution to tissues not known.

Protein Binding: 98–99%.

Metabolism and Excretion: Mostly metabolized by the liver. Converted to compounds with uricosuric (parahydroxy-sulfinpyrazone) and antiplatelet activity (sulfide metabolite).

Half-life: 3 hr (1 hr for parahydroxy-sulfinpyrazone; up to 13 hr for sulfide metabolite).

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity with oxyphenbutazone and phenylbutazone may exist.

Use Cautiously in: History of blood dyscrasias; History of GI bleeding; History of kidney stones; Neoplastic disease or radiation therapy (↑ risk of uric acid stone formation); Acute attacks of gout.

Interactions

Drug-Drug: ↑ risk of bleeding with aspirin, other NSAIDs, anticoagulants, cefoperazone, cefotetan, clopidogrel, eptifibatide, tirofiban, ticlopidine, valproic acid, or thrombolytic agents. ↓ blood levels and may ↓ effectiveness of nitrofurantoin, theophylline, or verapamil. Uricosuric effect may be ↓ by salicylates or niacin. Concurrent use of antineoplastics ↑ risk of ...