21-Médicaments de la goutte

V"21%MEDICAMENTS%DE%LA%GOUTTE%
1!
!
Pharmaetudes!
1!
Médicaments%utilisés%dans%le%traitement%de%la%goutte%
!
"#$%&'()(*+,-*'!.#'/0!&1/!/%/0,-10*2)'-'.0!&(,/'.0'!31./!41!+(*/'!3'!56)00'7!3'!-8-'!2)'!41!&4)&1(0!
3'/!$%&'()(*+,-*'/!/6.0!1/%-&06-10*2)'/9!:'/!3'(.*;('/!/6.0!31.5'(')/'/!&1(!4'!(*/2)'!2)#'44'/!('&(,/'.0'.0!
1)!.*<'1)!(,.14!'0!+1(3*12)'9!!
=1(-*!4'/!+1)/'/!3'!56)00'/!/'+6.31*('/7!*4!>1)0!/*5.14'(!4'/!56)00'/!3?6(*5*.'!*10(65;.'!@!!
- 1<'+!4'/!3*)(,0*2)'/!0$*1A*3*2)'/!!
- 1<'+!4'!=%(*A*.1-*3'!=BCB"DEF7!15'.0!1.0*0)G'(+)4')H!3,(*<,!3)!.*+60*.1-*3'9!!
!
"'/!-,3*+1-'.0/!1.0*I56)00')H!15*//'.0!/6*0!'.!*.$*G1.0!4'/!(,1+0*6./!*.>41--106*('/7!+#'/0!+'!2)'!>1*0!41!
+64+$*+*.'!'0!4'/!JBEK7!/6*0!'.!(,3)*/1.0!41!+6.+'.0(10*6.!3#1+*3'!)(*2)'!'.!3*-*.)1.0!/1!>6(-10*6.!&1(!*.$*G*0*6.!
3'!41!H1.0$*.'!6H%31/'!L1446&)(*.64M!6)!'.!3,5(131.0!4#1+*3'!)(*2)'!3,NO!>6(-,!&1(!4#)(10'!6H%31/'9!P'/!
)(*+6/)(*2)'/7!0%&'!&(6G,.,+*3'7!2)*!>1<6(*/'.0!4#,4*-*.10*6.!)(*.1*('!3#1+*3'!)(*2)'!6.0!,0,!41(5'-'.0!)0*4*/,/!
&1(!4'!&1//,9!!
!
1. Traitement%de%la%crise%aiguë%:%
!
1.1 %%%%AINS%:%
=6//;3'(1*'.0!).'!action%uricosurique!3,&'.31.0'!3'!41!36/'9!!
Q0*4*/,/!&6)(!0(1*0'(!4'/!-1.*>'/010*6./!36)46)(')/'/!1//6+*,'/!O!41!+(*/'!1*5R'9!!
B4/!/6.0!associés%à%la%colchicine%:!2)*!('&(,/'.0'!4'!0(1*0'-'.0!&'(-'001.0!3#*.0'((6-&('!4#1)06'.0('0*'.!3)!
&$,.6-;.'9!!
!
:'(01*./!JBEK!&6//;3'.0!).'!*.3*+10*6.!31./!4'!0(1*0'-'.0!3'/!1(0$(*0'/!-*+(6!+(*/0144*.'/!@!
- P*+46>,.1+!!
- Indométhacine!!!!000!3'!+$6*H!
- =*(6H*+1-!!
- BG)&(6>;.'!!
- S,06&(6>;.'9!!
"#*.36-,0$1+*.'!&(*/'!3'!-1.*;('!0(;/!&(,+6+'!+6./0*0)'(1*0!4'!-,3*+1-'.0!3'!+$6*H9!!
!
Rmq%:!"#1/&*(*.'!1)H!36/'/!*.>,(*')('/!O!T!5UN6)(!3*-*.)'!41!+41*(1.+'!3'!4#1+*3'!)(*2)'9!F44'!.'!36*0!&1/!80('!
)0*4*/,'9!!
!
1.2 %%%Colchicine%:%
• Définition,%mode%d'action%:%
- J4+146V3'7!/)G/01.+'!.10)('44'7!'H0(1*0'!3'!Colchicum)autumnale!
- :$12)'!-64,+)4'!3'!+64+$*+*.'!/'!>*H'!O!).'!-64,+)4'!3'!0)G)4*.'!'0!'-&8+$'!/1!&64%-,(*/10*6.!
'.!-*+(60)G)4'/9!"#1G/'.+'!6)!4#*./)>>*/1.+'!3'!-*+(60)G)4'/!1!&4)/*')(/!+6./,2)'.+'/!@!!
 W46+15'!3'!41!3*<*/*6.!+'44)41*('!1)!/013'!-,01&$1/'7!+'!2)*!'H&4*2)'!/6.!1+0*<*0,!
1.0*0)-6(14'!!
 B.$*G*0*6.!3'!41!-60*4*0,!3'!+'(01*.'/!+'44)4'/!36.0!4'/!5(1.)46+%0'/!2)*!.6(-14'-'.0!
+6.<'(5'.0!<'(/!4'/!+(*/01)H!3#1+*3'!)(*2)'!'0!&1(0*+*&'.0!O!41!(,1+0*6.!*.>41--106*('!!
 B.$*G*0*6.!3'!41!-*5(10*6.!*.0(1+'44)41*('!3'!+'(01*./!+6./0*0)1.0/!'0!*.$*G*0*6.!3'!41!
4*G,(10*6.!3'!5(1.)4'/!3#$*/01-*.'!&1(!4'/!-1/06+%0'/9!!
"1!+64+$*+*.'!'/0!'>>*+1+'!31./!4'!0(1*0'-'.0!3'!41!56)00'!&1(+'!2)#'44'!*.$*G'!41!-60*4*0,!3'/!4')+6+%0'/7!
+'!2)*!4'/!'-&8+$'!3#1>>4)'(!1)06)(!3'/!+(*/01)H!3#1+*3'!)(*2)'9!F44'!.#1!&1/!3'!&(6&(*,0,/!1.0*I*.>41--106*('/!
+6--'!4'/!54)+6+6(0*+6V3'/!'0!4'/!1.0*I*.>41--106*('/!.6.!/0,(6V3*'./!'0!.'!-63*>*'!&1/!4#,4*-*.10*6.!3'!4#1+*3'!
)(*2)'9!!

!
!
2!
- :'00'!1+0*6.7!31./!4'!+6.0'H0'!3'!41!56)00'7!<1!/#'H'(+'(!/)(!4'/!=E!100*(,/!&1(!+$*-*601+0*/-'!
<'(/!4'/!-*+(6+(*/01)H!3#)(10'!1)!/'*.!3'/!1(0*+)410*6./9!!+'/!=EE!.'!&')<'.0!&4)/!&$156+%0'(!
- :'!+6-&6/,!.#1!&1/!3#1+0*6.!1.145,/*2)'!-1*/!&'(-'0!3'!+1//'(!4'!+'(+4'!<*+*')H!3'!41!56)00'!@!!
4#$%&'()(*+,-*'!'.0(1X.'!).'!&(,+*&*010*6.!3'!-*+(6+(*/01)H!3#)(10'9!:')HI+*!/'!3,&6/'.0!31./!
4#1(0*+)410*6.!'0!&(6<62)'!).'!(,1+0*6.!*.>41--106*('!@!1>>4)H!3'!=E!'0!3'!-1+(6&$15'/9!:'/!
+'44)4'/!&$156+%0'.0!+'/!+(*/01)H!'0!4*G;('.0!*.!/*0)!3'!4#1+*3'!41+0*2)'!2)*!1G1*//'!4'!&Y!3)!
4*2)*3'!*.0(1I1(0*+)41*('!'0!>1<6(*/'!41!&(,+*&*010*6.!3'/!-*+(6+(*/01)H!3#)(10'!O!&1(0*(!3'!4#1+*3'!
)(*2)'!&41/-10*2)'9!!
!
• Formes%commercialisées%:%
- :64+$*+*.'!/')4'!@!COLCHICINE%HOUDÉ%®! ! Z!-5!!
- :64+$*+*.'!1//6+*,'!@!COLCHIMAX®!!!Z!-5!
!
• Pharmacocinétique%:%
- G*'.!1G/6(G,'!&1(!4'!0)G'!3*5'/0*>%
- /'!3*/0(*G)'!*.,514'-'.0!31./!4'/!0*//)/!@!4'/!+6.+'.0(10*6./!/6.0!,4'<,'/!31./!4'!('*.7!4'!>6*'7!41!
(10'!'0!4'/!4')+6+%0'/7!+'!2)*!'H&4*2)'!/6.!'>>'0!1.0*I56)00')H7!'0!G'1)+6)&!&4)/!>1*G4'/!31./!4'!
+6')(7!4'/!-)/+4'/!/2)'4'00*2)'/7!4'!+'(<'1)!'0!4'/!&6)-6./9!%
- -,01G64*/,'!'.!&4)/*')(/!&(63)*0/%
- ,4*-*.10*6.!'/0!(,.14'!'0!/)(06)0!G*4*1*('9!F44'!/)G*0!).!+%+4'!'.0,(6I$,&10*2)'7!+'!2)*!'H&4*2)'!'.!
&1(0*'!/1!06H*+*0,!3*5'/0*<'%
%
• Effets%secondaires%:%
- [(6)G4'/!3*5'/0*>/!@!3*1(($,'7!.1)/,'/7!<6-*//'-'.0/!!6.!&')(!36..'(!3'!4?B\]PBQ\^!'0!3)!
_]`J"FEF^!
- [(6)G4'/!.')(6-%6&10$*2)'/!(,<'(/*G4'/!
- JA66/&'(-*'!
- Q(0*+1*('7!,()&0*6./!+)01.,'/!-6(G*4*>6(-'/!
- C1('/!0(6)G4'/!$,-106465*2)'/!@!4')+6&,.*'/7!.')0(6&,.*'/7!0$(6-G6+%06&,.*'/!!
!
• Surdosage%:%
- =(63)*0!06H*2)'!&6)<1.0!'.0(1X.'(!41!-6(0!'.!+1/!3'!/)(36/15'!*-&6(01.09!!
- P6/'!-6(0'44'!@!ab!-5!!
- "1!+64+$*+*.'7!)0*4*/,'!O!&6/6465*'!.6(-14'7!31./!4'!0(1*0'-'.0!+)(10*>!6)!&(,<'.0*>!3'!41!56)00'7!
'/0!5,.,(14'-'.0!G*'.!064,(,'7!-1*/!46(/!3#*.06H*+10*6./!<646.01*('/!6)!1++*3'.0'44'/7!&1(!
'H'-&4'!&(*/'!3'!&4)/*')(/!-*44*5(1--'/7!'44'!'.0(1X.'!3'/!-1.*>'/010*6./!06H*2)'/!
'H0(8-'-'.0!5(1<'/!@!!
o [(6)G4'/!3*5'/0*>/!2)*!&')<'.0!1&&1(1X0('!0(;/!(1&*3'I-'.0!1&(;/!/6.!*.5'/0*6.!'0!
&'(/*/0'(!&4)/*')(/!N6)(/!!
o B./)>>*/1.+'!+*(+)4106*('!1<'+!,010!3'!+$6+!!
o J00'*.0'!$,-106465*2)'!2)*!1&&1(1X0!)40,(*')('-'.07!1<'+!3*/&1(*0*6.!3'/!
5(1.)46+%0'/!'0!&1(>6*/!3'/!&412)'00'/!!
o J46&,+*'!0(1./*06*('!>(,2)'--'.0!6G/'(<,'!46(/2)'!4'!-1413'!1!(,+)&,(,9!!
• B4!.#%!1!&1/!3#1.0*360'!3'!41!+64+$*+*.'!+6--'(+*14*/,!-1*/!).!1.0*+6(&/!1.0*+64+$*+*.'!1!36..,!3'!G6./!
(,/)4010/!1)!+6)(/!3'/!*.06H*+10*6./9!!
!
• Indications%:%
- J++;/!1*5)!3'!56)00'!@!+)(10*>!
- =(6&$%41H*'!3'/!1++;/!1*5)/!+$'A!4'!56)00')H!+$(6.*2)'!!LZ-5UNM!
- J++;/!1*5)/!3#1)0('/!1(0$(*0'/!-*+(6+(*/0144*.'/9!

V"21%MEDICAMENTS%DE%LA%GOUTTE%
3!
!
Pharmaetudes!
3!
- F44'!'/0!1)//*!&(6&6/,'!31./!4'!0(1*0'-'.0!3'!+'(01*.'/!-1413*'/!&1(0*+)4*;('/7!0'44'/!2)'!41!
-1413*'!&,(*63*2)'!6)!>*;<('!-,3*0'((1.,'..'!>1-*4*14'7!41!-1413*'!3'!W'$+'07!4#1-%46/'7!6)!
&4)/!+6--).'/7!0'44'/!2)'!41!+*(($6/'!14+664*2)'7!41!/+4,(6/'!'.!&412)'!'0!4'!&/6(*1/*/9!F44'!1!,0,!
)0*4*/,'!+6--'!1.0*.,6&41/*2)'9!!
!
• Posologies%:!:(*/'!1*5R'!3'!56)00'!@!!
- Z'(!c6)(!@!! ! Z!+&!-10*.7!-*3*!'0!/6*(!!T!-5UN!
- d;-'7!T;-'!N6)(!@!! ! Z!+&!-10*.!'0!/6*(!!!d!-5UN!
- a;-'!'0!1)!3'4O!@!! Z!+&!4'!/6*(!!!Z!-5UN!
- [(1*0'-'.0!3'!Zb!N!
- F>>*+1+*0,!(1&*3'!@!(,/)4010/!3;/!4'!4'.3'-1*.9!P*/&1(*0*6.!B.>41--10*6.!'.!ae!$!
- J((80!3,5('//*>!3)![(1*0'-'.0!
!
• Cas%particulier%de!COLCHIMAX!@!!
o :6-&6/*0*6.!@!
 Colchicine!Z!-5!
 Tiémonium!fb!-5!@!1.0*/&1/-63*2)'!3'!0%&'!10(6&*.*2)'!
 Poudre%d’opium!Zd7f!-5!@!1.145,/*2)'!
o :'(01*./!'>>'0/!/'+6.31*('/!L/)(06)0!'.!+1/!3'!/)(36/15'M!&')<'.0!80('!4'!>1*0!3'!+'/!13N)<1.0/7!
'.!&1(0*+)4*'(!3)!+6-&6/,!10(6&*.*2)'!@!!'>>'0/!1.0*+$64*.'(5*2)'/!@!
- K,+$'('//'!G)++14'!
- P*-*.)0*6.!3'!41!/,+(,0*6.!41+(%-14'!
- [(6)G4'/!3'!4?1++6--6310*6.!
- [1+$%+1(3*'!
- C,0'.0*6.!)(*.1*('!
!
!
2 Traitements%hypouricémiants%:%
B4/!/6.0!)0*4*/,/!'.!0(1*0'-'.0!3'!>6.3!3'!41!56)00'!6)!3'/!,010/!3#$%&'()(*+,-*'!1//6+*,/!O!3'/!
-1.*>'/010*6./!&10$6465*2)'/9!!
!
B4!%!1!T!+10,56(*'/!3'!/)G/01.+'!@!!
• B.$*G*0')(/!3'!4#)(*+6/%.0$;/'!!
• Q(*+6/)(*2)'/!
• Q(*+64%0*2)'/!!
!
Q.!+'(01*.!.6-G('!3'!+1(1+0,(*/0*2)'/!'0!&(,+1)0*6./!4')(!/6.0!+6--).'/!@!!
- :'!.'!/6.0!&1/!3'/!-,3*+1-'.0/!3'!41!+(*/'9!"'!0(1*0'-'.0!36*0!80('!*./01)(,!d!O!T!/'-1*.'/!1&(;/!41!>*.!
3'!41!+(*/'!!
- "'!0(1*0'-'.0!'/0!*.*0*,!'.!1//6+*10*6.!1<'+!41!+64+$*+*.'!O!36/'!&(6&$%41+0*2)'!LZ!-5UN6)(M!31./!4'/!d!O!T!
&('-*'(/!-6*/7!/*.6.!(*/2)'!3#).'!+(*/'!1*5)g9!!
- =1/!3#*.0'(()&0*6.!'.!+1/!3'!+(*/'9!!
!
!
2.1 %%%Inhibiteurs%de%l’uricosynthèse%:%
Allopurinol%ZYLORIC®%
!
• Définition%:%
- "#1446&)(*.64!'/0!).!inhibiteur%de%la%xanthine"oxydase7!'.A%-'!+1014%/1.0!41!G*6/%.0$;/'!3'!
4#1+*3'!)(*2)'9!!

!
!
4!
- :?'/0!).!1.1465)'!3'!4?$%&6H1.0$*.'!
!
- B4!*.0'(<*'.0!.6.!&1/!31./!41!G*6/%.0$;/'!3'/!G1/'/!&)(*2)'/!-1*/!31./!4')(!+101G64*/-'7!+'!2)*!
'H&4*2)'!2)#*4!'/0!G'1)+6)&!-*')H!064,(,!2)'!4'/!*.$*G*0')(/!3'!41!/%.0$;/'9!!
- "#1446&)(*.64!'/0!,514'-'.0!).!/)G/0(10!3'!41!H1.0$*.'I6H%31/'!2)*!4'!0(1./>6(-'!'.!).!
-,01G64*0'!4)*I-8-'!*.$*G*0')(!3'!4#'.A%-'9!:#'/0!+'!-,01G64*0'!2)*!'/0!'//'.0*'44'-'.0!O!
4#6(*5*.'!3'!4#1+0*6.!&$1(-1+6465*2)'!3'!4#1446&)(*.64!!!4?J446&)(*.64!'/0!36.+!).'%prodrogue!
- "#1446&)(*.647!O!>1*G4'!+6.+'.0(10*6.7!'/0!O!41!>6*/!).!/)G/0(10!'0!).!*.$*G*0')(!+6-&,0*0*>!3'!41!
H1.0$*.'!6H%31/'9!J!&4)/!>6(0'!+6.+'.0(10*6.7!*4!3'<*'.0!).!*.$*G*0')(!.6.!+6-&,0*0*>9!
"#1446&)(*.64!'/0!0(1./>6(-,!&1(!41!H1.0$*.'!6H%31/'!'.!1446H1.0$*.'!6)!6H%&)(*.647!2)*!'/0!4)*I
-8-'!).!*.$*G*0')(!.6.!+6-&,0*0*>!3'!41!H1.0$*.'I6H%31/'9!
- "#$%&6H1.0$*.'!'0!41!H1.0$*.'!2)*!/6.0!G+&!&4)/!/64)G4'/!2)'!4?1+*3'!)(*2)'!/6.0!,4*-*.,/!&1(!4'/!
)(*.'/9!!
!
!
!
• Effets%secondaires%:%
- =')0!*.3)*('!).!1++;/!3'!56)00'!'.!3,G)0!3'!0(1*0'-'.07!3?6h!41!.,+'//*0,!3?1//6+*'(!41!
:64+$*+*.'!1)!3,G)0!
- [(6)G4'/!3*5'/0*>/!@!.1)/,'/7!51/0(145*'/7!3*1(($,'/!!&('.3('!1&(;/!4'/!('&1/!
- C,1+0*6./!144'(5*2)'/!+)01.,'/!L/%.3!3'!"%'44M!6)!5,.,(14*/,'/!
- =G!Y,-106!LJ5(1.)46+%06/'M!'0!Y,&10*2)'!LY,&10*0'M!
!
• Interactions%médicamenteuses%:%%%INHIBITEUR%ENZYMATIQUE%
"#1446&)(*.64!3*-*.)'!4'!-,01G64*/-'!3'!+'(01*./!-,3*+1-'.0/!+'!2)*!&60'.0*14*/'!4')(/!'>>'0/!/'+6.31*('/!@!!
- =,.*+*44*.'/!3)!5(6)&'!J!@!1)5-'.010*6.!3'/!(,1+0*6./!+)01.,'/!!
- _*31(1G*.'!@!1)5-'.010*6.!3'/!0(6)G4'/!.')(6465*2)'/!!
- J.0*+615)41.0/!6(1)H!@!&60'.0*14*/10*6.!3)!(*/2)'!$,-6((15*2)'!!
- JA10$*6&(*.'7!-'(+1&06&)(*.'!@!1)5-'.010*6.!3'!4#*./)>>*/1.+'!-,3)441*('!+1(!4?J446&)(*.64!
(14'.0*0!4')(!-,01G64*/-'!
!
• Posologie%:%
- Q/)'44'!3'!Zbb!O!abb!-5UN6)(9!!
- J!1N)/0'(!'.!>6.+0*6.!3'/!<14')(/!3'!4#)(*+,-*'!'0!3'!4#)(10)(*'9!!
- [(1*0'-'.0!:$(6.*2)'!O!<*'!
%
Remarque%:%
"'!Fébuxostat%ADENURIC^!'/0!).!*.$*G*0')(!/,4'+0*>!3'!41!H1.0$*.'!6H%31/'!3'/0*.,!1)!0(1*0'-'.0!3'!
4#$%&'()(*+,-*'!'0!'.!100'.0'!3'!+6--'(+*14*/10*6.!LdbbeM9!K'/!1<1.015'/!/)(!4#144)&)(*.64!'.!)0*4*/10*6.!+6)(1.0'!
('/0'.0!O!&(,+*/'(9!
!
!
!
!

V"21%MEDICAMENTS%DE%LA%GOUTTE%
5!
!
Pharmaetudes!
5!
2.2 %%%Les%uricosuriques%:%
P')H!/)G/01.+'/!'H*/0'.09!F44'/!15*//'.0!'.!3*-*.)1.0!41!(,1G/6(&0*6.!0)G)41*('!3'!4#1+*3'!)(*2)'!'0!31./!).'!
-6*.3('!-'/)('!'.!1)5-'.01.0!/1!/,+(,0*6.!0)G)41*('9!!
!
P')H!&(,+1)0*6./!36*<'.0!80('!('/&'+0,'/!@!!
C10*6.!$%3(*2)'!G*+1(G6.10,'!/)>>*/1.0'!&6)(!,<*0'(!41!&(,+*&*010*6.!3'!4#1+*3'!)(*2)'!31./!4'/!)(*.'/!!
=1/!3#1//6+*10*6.!O!4#1/&*(*.'!2)*!58.'!4#1+0*6.!3'/!)(*+6/)(*2)'/!@!3*-*.)'!4?,4*-*.10*6.!3'!4?1+*3'!)(*2)'!
=('/+(*0/!46(/2)'!4#)(10)(*'!'/0!i!jbb-5Uda$!!
!
2.2.1 Probénicide%BENEMIDE®%:% Lfbb!-5M!
• F>>'0/!/'+6.31*('/!@!!
o F>>'0/!3*5'/0*>/!
o C,1+0*6./!144'(5*2)'/!
• B.3*+10*6./!@!
o `6)00'!!
o Y%&'()(*+,-*'/!&(*-*0*<'/!6)!/'+6.31*('/!/1./!*./)>>*/1.+'!(,.14'!!
• :6.0('I*.3*+10*6./!@!
o "*0$*1/'!)(*2)'!!
o Y%&'()(10)(*'!k!jbb!-5UN6)(!!
o B./)>>*/1.+'!(,.14'!/,<;('!!
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