Medicines that increase uric acid levels

Drug-induced hyperuricaemia

Find out about medicines that can increase uric acid levels.

Some medicines can increase uric acid levels. For most people, your body gets rid of extra uric acid and this brings your levels back to a normal range. However in others, the extra uric acid cannot be cleared and causes high uric acid levels (hyperuricaemia). The extra uric acid can build up in areas such as joints, causing pain and swelling. This is a condition called gout. Read more about gout.

Examples of medicines that increase uric acid levels

Medicines that increase uric acid levels can do so by:

  • causing your body to make too much uric acid
  • preventing your body from getting rid of extra uric acid in your urine when you pee.

The following is a list of some medicines that are known to increase uric acid levels

Examples of medicines that increase uric acid levels
  • Diuretics (see below) 
  • Aspirin low dose (less than 300 mg daily)
  • Nicotinic acid
  • Levodopa
  • Ciclosporin
  • Tacrolimus
  • Cytotoxic chemotherapy
  • Fructose
  • Testosterone
  • Pyrazinamide
  • Ethambutol

Diuretics

Diuretics are also called water pills or water tablets. Diuretics are commonly used to treat high blood pressure and heart failure. They work by helping your body get rid of extra salt (sodium) and water. Read more about diuretics.

The following diuretics are known to increase uric acid levels by preventing your kidneys from getting rid of the extra uric acid in your urine.

Diuretics that cause an increase in uric acid

Thiazide diuretics
  • Bendroflumethiazide
  • Chlortalidone
  • Indapamide
  • Metolazone
  • Hydrochlorothiazide, which is available only in combination with other medicines:
    • hydrochlorothiazide plus quinapril, is called Accuretic
    • hydrochlorothiazide plus losartan, is called Arrow-Losartan & Hydrochlorothiazide
    • hydrochlorothiazide plus amiloride, is called Moduretic
Loop diuretics
  • Furosemide
  • Bumetanide

How is medicine-related hyperuricaemia diagnosed? 

Medicine-related hyperuricaemia is diagnosed when an increase in serum uric acid concentration is seen within a few days or weeks after starting the medicine. Your doctor will work out whether to continue the medicine or if there is a more suitable alternative.

Do not stop taking your medicine suddenly. Instead talk to your doctor or pharmacist if you have concerns. Some medicines need to be stopped gradually, as sudden withdrawal can make the effects worse.

Things you can do about hyperuricaemia

✔ Make sure you tell your doctor, as well as all healthcare providers, about any other medicines you are taking (including over-the-counter medicines, vitamins or herbal remedies).

✔ Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney or heart disease. 

✔ Follow your healthcare provider's instructions regarding lowering your blood uric acid level and treating your hyperuricaemia. If your blood levels are very high, they may prescribe medicines to lower the uric acid levels to a safe range. Read more about medicines for gout
 
✔ Uric acid can also be reduced by avoiding some foods and drinks such as: 

  • all organ meats (such as liver), meat extracts and gravy
  • seafood
  • yeasts and yeast extracts (such as beer, and alcoholic beverages)
  • asparagus, spinach, beans, peas, lentils, oatmeal, cauliflower and mushrooms
  • fizzy drinks as they often contain fructose which can make your gout worse.

✔ Keep hydrated and drink plenty of water (at least 8 glasses per day) unless there is a medical reason not to do so.

✔ Keep active by exercising.

✔ Lose weight if you need to.

References

  1. Salem CB, Slim R, Fathallah N, Hmouda H. Drug-induced hyperuricaemia and gout. Rheumatology 2017;56(5):679-688.
  2. Hyperuricemia (high uric acid) Chemocare, US
Credits: Sandra Ponen, Pharmacist. Reviewed By: Maya Patel, Pharmacist, Auckland Last reviewed: 15 Sep 2021