[How to select and use urate lowering agents for hyperuricemia]

Two classes of urate lowering agents, i.e. uricosuric agents and allopurinol, are available for the treatment of hyperuricemia. To prevent the formation of urinary urate stones and possible damage to liver function, it is recommended to use uricosuric agents in those patients with underexcretion of urate, and allopurinol in those with overproduction. Urinary uric acid/creatinine ratio is a convenient index to determine these phenotypes. These agents should be started to prescribe from the minimal dose to prevent the gouty arthritis which is easily evoked in the first several months after the introduction of these agents. An uric acid level between 5.0 and 6.4 mg/dl had minimal occurence of gouty attack during the first six months of the drug therapy.