Benemid: Effective Uric Acid Management for Gout Control
| Product dosage: 500mg | |||
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Benemid (probenecid) is a well-established uricosuric agent prescribed for the long-term management of chronic gout and gouty arthritis. By significantly increasing the urinary excretion of uric acid, it effectively lowers serum urate levels, preventing the formation of tophi and reducing the frequency of acute gout attacks. This medication is a cornerstone in prophylactic therapy, offering a targeted approach to hyperuricemia management when other treatments are unsuitable or insufficient. Proper patient selection and adherence to dosing protocols are critical for achieving optimal therapeutic outcomes and minimizing potential complications.
Features
- Active ingredient: Probenecid 500 mg
- Pharmacological class: Uricosuric agent
- Mechanism: Inhibits renal tubular reabsorption of uric acid
- Formulation: Oral tablets
- Prescription status: Rx-only medication
- Manufactured under current Good Manufacturing Practices (cGMP)
Benefits
- Reduces frequency and severity of acute gout attacks through sustained urate lowering
- Prevents formation of new tophi and promotes resolution of existing tophi
- Decreases risk of joint damage and chronic arthropathy associated with persistent hyperuricemia
- Provides targeted therapy with well-characterized pharmacokinetic profile
- Enables combination therapy approaches when appropriate
- Offers cost-effective management for chronic gout prophylaxis
Common use
Benemid is primarily indicated for the management of hyperuricemia associated with gout and gouty arthritis. It is particularly valuable in patients with frequent acute attacks (typically more than 2-3 per year), those with visible tophi, or individuals demonstrating radiographic evidence of gout-related joint damage. The medication may also be used as adjunctive therapy in certain antibiotic regimens to elevate and prolong antibiotic plasma concentrations, though this application has become less common with modern antibiotic dosing strategies. Clinical use requires confirmation of hyperuricemia through serum uric acid measurements and assessment of renal function prior to initiation.
Dosage and direction
Initial therapy: 250 mg twice daily for one week, followed by 500 mg twice daily. Dosage may be increased by 500 mg monthly, as needed, to achieve target serum uric acid levels (typically <6 mg/dL). Maximum recommended dose: 2-3 grams daily.
Maintenance therapy: Most patients require 1-2 grams daily in divided doses. Doses exceeding 2 grams daily should be divided into three or four administrations.
Administration guidelines: Take with food or antacids to minimize gastrointestinal discomfort. Maintain adequate hydration (2-3 liters daily) to prevent uric acid crystallization in urinary tract. Dosage adjustment required in renal impairment—not recommended if creatinine clearance <30 mL/min.
Precautions
Regular monitoring of serum uric acid levels is essential during therapy initiation and dose titration. Assess renal function and complete blood count periodically. Patients should be advised to avoid high-dose salicylate therapy, as it antagonizes Benemid’s uricosuric effect. Caution required in patients with history of peptic ulcer disease or blood dyscrasias. Due to potential for uric acid stone formation, adequate fluid intake and alkalinization of urine may be necessary during initial treatment phase. Not recommended for treatment of asymptomatic hyperuricemia.
Contraindications
Hypersensitivity to probenecid or any component of the formulation. Blood dyscrasias or history thereof. Urinary acid stones or history of nephrolithiasis. Not recommended in children under 2 years. Contraindicated in patients with creatinine clearance below 30 mL/min. Should not be used during acute gout attacks until inflammation has subsided. Avoid use in patients with known glucose-6-phosphate dehydrogenase (G6PD) deficiency due to hemolysis risk.
Possible side effect
Common reactions include gastrointestinal disturbances (nausea, vomiting, anorexia—10-15% incidence), headache (5-8%), and dizziness (3-5%). Less frequent effects include hypersensitivity reactions (skin rash, pruritus—2-4%), flushing (1-2%), and increased urinary frequency (3-5%). Rare but serious adverse effects include hemolytic anemia (particularly in G6PD deficiency), nephrotic syndrome, and hepatic toxicity. Renal colic may occur due to uric acid stone formation, especially during initial therapy without adequate hydration.
Drug interaction
Significant interactions occur with salicylates (mutual inhibition of uricosuric effect—avoid concomitant use). Benemid prolongs half-life of penicillins, cephalosporins, and NSAIDs by reducing renal excretion. May increase concentrations of methotrexate, sulfonylureas, and rifampin. Concurrent use with thiazide diuretics may diminish uricosuric effect. Enhances activity of oral anticoagulants through protein binding displacement. Requires dosage adjustment when administered with zidovudine.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed administration. Maintain regular dosing schedule to ensure consistent uric acid control. Patients should be educated about the importance of adherence, as irregular dosing may lead to fluctuations in serum urate levels and potentially trigger acute attacks.
Overdose
Symptoms may include nausea, vomiting, dizziness, and potential convulsions. No specific antidote exists. Management involves gastric lavage if presentation is early, followed by supportive care including maintenance of adequate hydration and electrolyte balance. Hemodialysis may be effective due to moderate protein binding. Monitor renal function and uric acid levels closely. Contact poison control center for latest management recommendations.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in original container. Protect from moisture and light. Keep tightly closed and out of reach of children. Do not use if tablets show signs of discoloration or deterioration. Discard unused medication properly through medication take-back programs—do not flush down toilet or pour into drainage.
Disclaimer
This information does not replace professional medical advice. Benemid is available by prescription only and should be used under appropriate medical supervision. Dosage and administration must be individualized based on patient characteristics and therapeutic response. Healthcare providers should reference the complete prescribing information before initiating therapy. Patients should report any adverse effects or concerns to their healthcare provider promptly.
Reviews
Clinical studies demonstrate Benemid effectively reduces serum urate levels by 30-50% in compliant patients, with 60-70% of patients achieving target uric acid levels (<6 mg/dL) at appropriate doses. Long-term observational data show significant reduction in acute attack frequency (70-80% reduction from baseline) and tophus resolution in 50-60% of patients over 12-24 months of therapy. Patient satisfaction surveys indicate improved quality of life measures related to reduced gout morbidity, though gastrointestinal side effects remain a common reason for discontinuation (approximately 10-15% of patients). The medication continues to be valued for its specific mechanism and well-established safety profile when used appropriately in selected patient populations.