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[Pharmacology](https://durgical.com/en/pharmacology/) · Class

# Other antigout agents

Medicines for gout that do not block xanthine oxidase: colchicine for flares, probenecid to pass more urate, and pegloticase to break it down.

Updated 2026-11-01

## What they are

Gout is treated in two ways: calming the flare and lowering urate over the long term. Colchicine treats and prevents flares; probenecid is a uricosuric that makes the kidney excrete more urate; pegloticase is an enzyme infusion for severe gout that does not respond to other urate-lowering drugs.

## Mechanism of action

Colchicine binds tubulin and stops microtubules forming, so neutrophils cannot migrate, degranulate or assemble the inflammasome that releases IL-1β. Probenecid blocks urate reabsorption in the proximal tubule (mainly through URAT1). Pegloticase is a pegylated uricase that oxidises uric acid to allantoin, which is more soluble.

Target: Tubulin (colchicine), URAT1 urate transporter (probenecid), uric acid itself (pegloticase)

## Key points

- Colchicine has a narrow margin: diarrhoea and vomiting are the first signs of toxicity, and overdose can be fatal.
- Colchicine with strong CYP3A4 or P-glycoprotein inhibitors (clarithromycin, protease inhibitors, ciclosporin, verapamil, grapefruit juice) can be fatal; contraindicated with kidney or liver impairment.
- Probenecid: not started during a flare, avoided with uric acid stones; salicylates cancel its effect; it raises penicillin levels.
- Pegloticase: test for G6PD deficiency first (haemolysis, methaemoglobinaemia); anaphylaxis risk at every infusion.

## Drugs in this class

- [**Colchicine** An old plant-derived tablet that calms gout flares and familial Mediterranean fever. Small margin: diarrhoea warns of… β-tubulin (microtubules)](https://durgical.com/en/pharmacology/colchicine/)
- [**Probenecid** A uricosuric tablet that makes the kidneys pass more uric acid. It also keeps penicillin in the blood longer. Urate transporter URAT1 (and organic anion transporters OAT1 and OAT3)](https://durgical.com/en/pharmacology/probenecid/)
- [**Pegloticase** An enzyme infusion that breaks down uric acid, for severe gout that does not respond to other drugs. G6PD is tested… Uric acid (the drug is the enzyme uricase)](https://durgical.com/en/pharmacology/pegloticase/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which antigout drug works on neutrophils rather than on uric acid?

Colchicine: it blocks microtubule formation and so neutrophil migration and inflammasome activation.

## Why is aspirin avoided with probenecid?

Salicylates antagonise its uricosuric action.

## What does pegloticase turn uric acid into?

Allantoin, a more soluble product excreted in the urine.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - COLCHICINE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=11a62c34-db88-4a79-81a1-59b316d41d66) (DailyMed (U.S. National Library of Medicine), 2024); [DailyMed - PROBENECID tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=65b4888c-d49a-433f-9bfd-17880ae40069) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 42 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/other-antigout-agents/