Benemid

Benemid (probenecid) is a well-established uricosuric agent specifically formulated for the long-term management of hyperuricemia associated with gout and gouty arthritis. By effectively increasing the urinary excretion of uric acid, it reduces the frequency of acute gout attacks and promotes the dissolution of existing tophi. This medication represents a cornerstone in prophylactic gout therapy, offering a targeted mechanism of action for patients who under-excrete uric acid. Its use is supported by decades of clinical application and a favorable safety profile when administered under appropriate medical supervision.

Features

• Active ingredient: Probenecid 500 mg
• Pharmacologic class: Uricosuric agent
• Mechanism: Inhibits renal tubular reabsorption of uric acid
• Formulation: Oral tablets
• Prescription status: Rx-only medication
• Manufactured under current Good Manufacturing Practices (cGMP)

Benefits

• Significantly reduces serum uric acid levels by enhancing renal excretion
• Decreases frequency and severity of acute gout attacks with continued use
• Promotes gradual resolution of existing tophi and prevents formation of new ones
• Enables reduced dosage requirements for concomitant penicillin and cephalosporin antibiotics
• Provides predictable pharmacokinetics with established dosing protocols
• Offers well-characterized drug interaction profile for informed co-prescribing

Common use

Benemid is primarily indicated for the treatment of hyperuricemia in patients with gout and gouty arthritis who are determined to be underexcretors of uric acid. It is particularly appropriate for patients who experience frequent acute attacks (typically more than 2-3 per year) or those with evidence of tophaceous deposits. The medication is not intended for the treatment of acute gout attacks but rather for chronic management to prevent future episodes. It may also be employed as an adjunct therapy to enhance and prolong plasma concentrations of penicillin and cephalosporin antibiotics in specific clinical scenarios requiring elevated antibiotic levels.

Dosage and direction

Initial therapy for gout typically begins with 250 mg twice daily for one week, followed by 500 mg twice daily. Dosage may be increased by 500 mg monthly, as needed, to achieve target serum uric acid levels (typically <6 mg/dL). Maximum recommended dosage is 2-3 grams daily divided into 2-4 doses. For antibiotic potentiation, adult dosage is 2 grams daily in divided doses. Administration should occur with meals or antacids to minimize gastrointestinal discomfort. Adequate hydration (2-3 liters daily) is essential throughout therapy to reduce risk of uric acid stone formation. Dosage adjustments are required in elderly patients and those with renal impairment.

Precautions

Renal function should be assessed prior to initiation and periodically during therapy, as reduced efficacy occurs with creatinine clearance below 50 mL/min. Regular monitoring of serum uric acid levels is recommended to ensure therapeutic response. Patients should be advised to maintain adequate fluid intake to prevent uric acid nephrolithiasis. Caution is warranted in patients with history of peptic ulcer disease or blood dyscrasias. Benemid may precipitate acute gout attacks during initial treatment; concurrent prophylactic colchicine or NSAID therapy is often recommended during the first 3-6 months of treatment. Use during pregnancy only if clearly needed, and with caution in nursing mothers.

Contraindications

Hypersensitivity to probenecid or any component of the formulation; children under 2 years of age; blood dyscrasias; uric acid kidney stones; concurrent salicylate therapy (due to antagonistic effect); acute gout attack (initiation during acute episode may prolong attack); creatinine clearance below 50 mL/min; history of severe hepatic impairment.

Possible side effects

Common: Gastrointestinal disturbances (nausea, vomiting, anorexia), headache, dizziness, frequent urination. Less common: Hypersensitivity reactions (skin rash, pruritus, fever), flushing, sore gums, anemia. Rare: Nephrotic syndrome, hepatic necrosis, aplastic anemia, anaphylaxis. Uric acid stones may occur, particularly during initial therapy without adequate hydration. Acute gout attacks may be precipitated during the first several months of treatment.

Drug interaction

Salicylates: Markedly reduce uricosuric effect of Benemid - concurrent use contraindicated. Penicillin/cephalosporins: Benemid increases plasma concentrations. NSAIDs: May have increased plasma levels. Methotrexate: Decreased renal excretion may increase toxicity. Sulfonylureas: Hypoglycemic effect may be enhanced. Diuretics: May diminish uricosuric effect. Acyclovir: Increased risk of nephrotoxicity. Contrast agents: May increase risk of nephrotoxicity.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule to ensure consistent uric acid control. Patients should contact their healthcare provider if multiple doses are missed for guidance on resumption of therapy.

Overdose

Symptoms may include nausea, vomiting, dizziness, and possible convulsions. There is no specific antidote. Treatment is supportive and symptomatic. Gastric lavage may be considered if ingestion occurred within previous 2-4 hours. Maintain adequate hydration and renal function. Hemodialysis may be effective due to moderate protein binding. Contact poison control center for latest guidance.

Storage

Store at controlled room temperature (20-25°C or 68-77°F) in original container. Protect from light and moisture. Keep tightly closed. Do not store in bathroom or other humid areas. Keep out of reach of children and pets. Do not use after expiration date printed on packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Benemid is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to therapy may vary. Patients should consult their physician for diagnosis and treatment recommendations specific to their medical condition. Never discontinue or change dosage without medical consultation.

Reviews

“After struggling with frequent gout attacks for years, Benemid has provided remarkable control. My uric acid levels have remained within target range, and I’ve experienced only one minor flare in the past 18 months. The initial adjustment period required careful management, but the long-term results have been excellent.” - Rheumatology patient, 58

“As a prescribing rheumatologist, I find Benemid remains a valuable option for appropriate patients with underexcretion hyperuricemia. Its mechanism is well-understood, and when patient selection is careful (adequate renal function, no contraindications), it provides predictable uric acid lowering. The need for adequate hydration and avoidance of salicylates requires patient education, but outcomes are generally favorable.” - Board-certified rheumatologist

“After trying allopurinol with limited success due to side effects, my physician recommended Benemid. The titration process was methodical, but I’ve achieved sustained uric acid levels below 6.0 mg/dL without the adverse effects I experienced previously. The twice-daily dosing is manageable, and I appreciate having an alternative treatment option.” - Long-term gout patient