Understanding High Uric Acid (Hyperuricemia)
Uric acid is a natural waste product created when the body breaks down purines, which are substances found in human cells and in many foods [1.8.1]. Normally, your kidneys filter uric acid out of the blood and excrete it through urine [1.8.1]. However, if your body produces too much uric acid or your kidneys don't remove enough of it, levels can build up in the blood—a condition known as hyperuricemia [1.2.1].
Over time, high uric acid can lead to serious health issues. The most well-known complication is gout, a painful form of arthritis that occurs when sharp uric acid crystals accumulate in the joints, causing intense inflammation, swelling, and pain [1.2.4]. These crystals can also form in the kidneys, leading to kidney stones [1.2.4]. Some studies also indicate Filipinos might have a genetic predisposition to high uric acid levels, making management crucial [1.7.2, 1.7.4].
First Line of Defense: Lifestyle and Diet
Before or alongside medication, doctors will always recommend lifestyle changes. Medication is most effective when supported by a healthy lifestyle [1.6.5].
Key Dietary Adjustments
- Limit High-Purine Foods: Reduce intake of red meat (beef, lamb), organ meats (liver), certain seafood (sardines, shellfish), and some vegetables like mushrooms and spinach [1.9.1, 1.8.1].
- Avoid Sugary Drinks and Alcohol: Beverages sweetened with high-fructose corn syrup and alcohol (especially beer) are known to increase uric acid levels and can trigger gout attacks [1.8.2, 1.9.2].
- Stay Hydrated: Drinking plenty of water (around 8 glasses daily) helps your kidneys flush uric acid from your system [1.8.6].
- Incorporate Beneficial Foods: Low-fat dairy products, cherries, and foods high in Vitamin C (like citrus fruits) may help lower uric acid levels [1.8.6, 1.8.5].
Prescription Medications to Lower Uric Acid in the Philippines
For chronic hyperuricemia or recurrent gout, a doctor will prescribe medications. These are not for treating acute pain but for long-term management to lower serum urate levels below 6 mg/dL [1.6.6]. In the Philippines, the following are the primary options available:
Allopurinol
Allopurinol is the most commonly prescribed, first-line medication for lowering uric acid [1.2.1, 1.6.1]. It belongs to a class of drugs called xanthine oxidase inhibitors [1.2.6]. It works by blocking the action of xanthine oxidase, an enzyme the body uses to produce uric acid [1.2.6].
- Common Brand Names in the Philippines: Zyloprim, Allurase, Purinase, Llanol, RiteMED Allopurinol [1.2.3, 1.3.3, 1.3.4].
- How It's Taken: Typically started at a low dose (e.g., 100 mg/day) and gradually increased by the doctor to reach the target uric acid level [1.6.4].
- Potential Side Effects: The most common side effect is a skin rash. Others can include fever, nausea, and changes in liver function tests [1.2.4]. It is crucial to report any rash to your doctor immediately.
Febuxostat
Febuxostat is another xanthine oxidase inhibitor, working similarly to Allopurinol by blocking uric acid production [1.2.5]. It is often prescribed as an alternative for patients who cannot tolerate Allopurinol or for those with moderate chronic kidney disease, as it is primarily processed by the liver [1.2.1, 1.2.6].
- Common Brand Names in the Philippines: Atenurix, Febuday, Urica, Lesurix, RiteMED Febuxostat [1.2.2, 1.4.1, 1.4.3, 1.4.2, 1.4.6].
- How It's Taken: Usually started at 40 mg per day and can be increased if necessary [1.6.1].
- Potential Side Effects: Side effects may include rash, nausea, and reduced liver function. It's noted to carry a potential increased risk of heart-related issues in some patients, a factor your doctor will consider [1.2.4].
Probenecid
Probenecid works differently. It is a uricosuric agent, meaning it helps the kidneys excrete more uric acid in the urine [1.2.4, 1.5.4]. It is typically recommended for patients whose bodies "under-excrete" uric acid, provided they have good kidney function [1.2.1].
- Availability in the Philippines: Probenecid is available by prescription in the Philippines [1.5.2, 1.5.3].
- How It's Taken: Dosing is determined by a physician, often starting low and increasing as needed [1.5.3]. Adequate hydration is essential to prevent the formation of kidney stones [1.2.6].
- Potential Side Effects: Includes rash, stomach upset, and an increased risk of developing kidney stones [1.2.4].
Comparison of Uric Acid Lowering Medications
| Feature | Allopurinol | Febuxostat | Probenecid |
|---|---|---|---|
| Mechanism | Blocks uric acid production (Xanthine Oxidase Inhibitor) [1.2.6] | Blocks uric acid production (Xanthine Oxidase Inhibitor) [1.2.6] | Increases uric acid removal by kidneys (Uricosuric) [1.2.6] |
| Primary Use | First-line treatment for most patients [1.6.1] | Alternative to Allopurinol, useful in moderate kidney disease [1.2.1, 1.6.1] | For patients who "under-excrete" uric acid with good kidney function [1.2.1] |
| Common Brands (PH) | Zyloprim, Allurase, Purinase [1.2.3] | Atenurix, Febuday, Urica [1.2.2, 1.4.1] | Available by prescription [1.5.2] |
| Key Consideration | Requires dose adjustment in kidney disease [1.6.4] | May be preferred in moderate kidney disease; monitor for heart issues [1.2.1, 1.2.4] | Not for patients with a history of kidney stones or poor kidney function [1.2.6] |
The Non-Negotiable Role of Medical Supervision
It is critical to emphasize that all these medications require a doctor's prescription and ongoing supervision [1.3.3, 1.4.2]. Self-medicating is dangerous. A doctor will diagnose the cause of your high uric acid, determine the correct medication and dosage based on your overall health (especially kidney and liver function), and monitor for side effects [1.6.1]. When starting these medications, a doctor may also prescribe a short-term anti-inflammatory drug like colchicine or an NSAID to prevent gout flares that can occur as uric acid levels begin to change [1.6.2].
Conclusion
In the Philippines, the primary medicines for lowering uric acid are Allopurinol, Febuxostat, and Probenecid, all of which require a prescription. Allopurinol is the standard first-choice treatment, with Febuxostat serving as a key alternative. The choice of medicine depends entirely on an individual's health profile, especially their kidney function. Effective management always combines this medical treatment with crucial lifestyle and dietary adjustments for the best long-term outcomes.
For more information on gout management guidelines, you can refer to resources from the American College of Rheumatology, which are widely referenced globally. https://www.rheumatology.org/practice-quality/clinical-support/clinical-practice-guidelines/gout
