[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Other antigout agents](https://durgical.com/en/pharmacology/classes/other-antigout-agents/) › Pegloticase

[Pharmacology](https://durgical.com/en/pharmacology/) · [Other antigout agents](https://durgical.com/en/pharmacology/classes/other-antigout-agents/)

# Pegloticase

An enzyme infusion that breaks down uric acid, for severe gout that does not respond to other drugs. G6PD is tested first; reactions are watched for.

Updated 2026-11-01

- Class: [Other antigout agents](https://durgical.com/en/pharmacology/classes/other-antigout-agents/)
- Target: Uric acid (the drug is the enzyme uricase)
- ATC code: M04AX02

## Mechanism of action

Humans lack a working uricase, so uric acid is their end product. Pegloticase is a recombinant urate oxidase linked to polyethylene glycol: it oxidises uric acid to allantoin, which is much more soluble and is excreted in the urine, and urate falls quickly. The reaction also produces hydrogen peroxide, which is why people with G6PD deficiency can develop haemolysis and methaemoglobinaemia. Antibodies against the drug can appear; they cause loss of effect and more infusion reactions.

- Pegylated uricase circulates in the blood
- Oxidises uric acid to allantoin
- Allantoin is soluble and leaves in urine
- Urate and tophi shrink

## Pharmacokinetics

**Absorption**
Intravenous infusion only

**Metabolism**
Broken down like other proteins; antibodies against it can speed its clearance

## Indications

- Chronic gout in adults who cannot take or did not respond to other urate-lowering drugs, alone or with methotrexate [Gout →](https://durgical.com/en/conditions/gout/)

## Adverse effects

### Common

- Gout flares in the first months
- Nausea, vomiting, constipation
- Redness, itching, hives

### Serious (rare, important)

- Anaphylaxis and infusion reactions, most often within hours of the infusion but possible at any time
- Haemolysis and methaemoglobinaemia in G6PD deficiency

## Contraindications

- G6PD deficiency

## Key interactions

**Oral urate-lowering drugs (allopurinol, febuxostat, probenecid)**
Usually not given together with pegloticase.

**Methotrexate**
Can be combined on purpose with pegloticase (with folic acid); methotrexate's own toxicity then applies.

## What is monitored

- G6PD test before starting, especially in people of African, Mediterranean or South Asian ancestry
- Serum uric acid before each infusion: a rise suggests antibodies and higher reaction risk
- Vital signs and symptoms during and after the infusion

## Administration and safety

- Intravenous infusion over hours, given by a doctor or nurse in a healthcare setting able to treat anaphylaxis.
- Premedication may be given before each infusion to help prevent reactions.
- The person is observed after the infusion.

## Nursing care

- Confirm the G6PD result before the first infusion.
- Check that oral urate-lowering drugs have been stopped.
- Watch for wheezing, throat or lip swelling, hives, flushing, chest pain or fainting; stop or slow the infusion and call the team.
- Ask about heart failure before each infusion.

## Pregnancy and breastfeeding

Human data are limited; the treating team weighs benefits and risks.

## Memory aid

PEG-loticase: PEG-ged uricase — Pre-test G6PD, Expect reactions, Get a urate level before each dose.

## Test yourself

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

## Which enzyme deficiency must be ruled out before pegloticase, and why?

G6PD deficiency: the reaction makes hydrogen peroxide, which can cause haemolysis and methaemoglobinaemia.

## What does a rising uric acid level between pegloticase infusions suggest?

Antibodies against the drug, with loss of effect and a higher risk of infusion reactions.

## Why do humans need a drug like pegloticase to break down uric acid?

Humans lack a functional uricase, so uric acid is the end product of purine breakdown.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/pegloticase/)

## Related drugs

- [Allopurinol](https://durgical.com/en/pharmacology/allopurinol/)
- [Febuxostat](https://durgical.com/en/pharmacology/febuxostat/)
- [Probenecid](https://durgical.com/en/pharmacology/probenecid/)
- [Colchicine](https://durgical.com/en/pharmacology/colchicine/)

## Related conditions

- [Gout](https://durgical.com/en/conditions/gout/)

[← Back to the class: Other antigout agents](https://durgical.com/en/pharmacology/classes/other-antigout-agents/)

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

Sources: [Pegloticase Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a611015.html) (MedlinePlus (U.S. National Library of Medicine), 2022); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 42 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=M04AX02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/pharmacology/pegloticase/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/pegloticase/