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Probenecid 💊
Always check the BNF link here or equivalent for prescribing advice- 🧪 Probenecid is a uricosuric drug that has historically also been used to boost concentrations of other drugs (e.g. penicillin).
- 📌 Occasionally misused to mask drugs in athletes’ urine screens.
⚙️ Actions
- 🚫 Blocks transport of organic acids across renal tubular membranes, reducing their excretion.
- 💧 Actively excreted in the proximal convoluted tubule, reabsorbed in the distal tubule.
- ⬇️ Reduces uric acid reabsorption and ⬆️ increases renal excretion of urate.
🎯 Indications
- 🦶 Gout / Hyperuricaemia: increases uric acid clearance.
- 💉 Historically used to prolong penicillin levels in plasma.
- 🚫 Misuse in sport: used to mask drug presence in urine analysis (banned in competitive athletics).
🔄 Interactions
- ⬆️ Increases blood concentrations of oseltamivir and some antivirals.
- 🚫 Aspirin reduces the uricosuric effect and should be avoided.
- 💊 Can affect levels of some antibiotics and antivirals (consult BNF for full list).
⚠️ Side Effects
- 🤢 Dyspepsia, GI upset.
- 🌸 Allergic reactions (rash, pruritus).
- 🧪 Rare: nephrolithiasis, anaemia, or uric acid kidney stones with long-term use.
📊 Dose
- 💊 Start: Probenecid 250 mg BD PO.
- ⬆️ Titrate according to serum urate levels.
- 📌 Usual maximum dose: 2 g/day.
- ⚠️ Ensure good hydration to reduce kidney stone risk.
📚 Teaching Points
- 🔑 Not first-line for gout - now largely replaced by allopurinol and febuxostat.
- 💧 Uricosuric effect requires good renal function; avoid in renal impairment.
- 🚫 Contraindicated in patients with history of uric acid kidney stones.
- ⚖️ Interesting historically: used in WWII to prolong scarce penicillin supplies.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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