salicylates and gout

Last reviewed 06/2022

• some drugs have a paradoxical effect on the renal tubular handling of urate, low doses causing retention and high doses uricosuria
  • biphasic response is most readily demonstrated with salicylate
  • salicylates in low dose inhibit the renal tubular secretion of uric acid, whereas in higher doses they inhibit both secretion and reabsorption. With the high doses, interference with reabsorption predominates so that the net effect is uricosuric
  • the hyperuricaemic effect of small doses of salicylates is probably of little practical importance, although of course a careful drug history must always be taken for diagnostic purposes
  • small doses of aspirin (75 mg daily) are given to patients at high cardiovascular risk
    • plasma and urinary levels of salicylate in these subjects must be extremely low and their effect upon uric acid levels has not been documented; it is unlikely to be significant

Reference:

• (1) Scott JT.Drug-induced gout. Baillière's Clinical Rheumatology 1991;5 (1): 39-60.