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Drugs that increase uric acid excretion

Drugs that increase uric acid excretion
Class Agent(s) Comment
Primary uricosurics Probenecid, sulfinpyrazone*, benzbromarone*, lesinurad  
Urate oxidase (uricolytics) Pegloticase, rasburicase Converts uric acid to allantoin (inactive water soluble metabolite).
Drugs with secondary uricosuric effect
Angiotensin-converting enzyme (ACE) inhibitors Enalapril, captopril Other ACE inhibitors do not seem to increase uric acid excretion.
Angiotensin II receptor blocker (ARB) Losartan Only ARB that significantly lowers serum uric acid. May counteract uric acid increase due to thiazide or cyclosporine.
Calcium channel blockers, dihydropyridine Amlodipine, felodipine, nitrendipine, nicardipine Shown to decrease serum uric acid in patients taking cyclosporine following renal graft.
Fibric acid derivative Fenofibrate (micronized) Significant uricosuric effect; data are lacking on effect of other fibrates.
Statins Atorvastatin Modest effect; studies of other statins demonstrated inconsistent or no effect.
Anti-infectives Trimethoprim-sulfamethoxazole, ampicillin, rifampin, isoniazid  
Hormone replacement therapy Estrogen  
Salicylates (high doses), aspirin, selected NSAIDs Diflunisal, aspirin (high dose >3 g/day and low dose 75 mg/day), sulindac, phenylbutazone* Moderate doses of aspirin can cause uric acid retention.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors Canagliflozin, dapagliflozin, empagliflozin, ertugliflozin Effect likely mediated by the inhibitory effect of glycosuria on urate reabsorption.
* Not available in United States. Limited availability in other countries.
Reference:
  1. Daskalopoulou SS, Tzovaras V, Mikhailidis DP, Elisaf M. Effect of serum uric acid levels of drugs prescribed for indications other than treating hyperuricaemia. Curr Pharm Des 2005; 11:4161.
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