Adult Dosing
Gout
- Recommended dose (initial): 250 mg PO bid x 1 week
- Recommended dose (maintenance): 500 mg PO bid; if symptoms persist or 24 hour urate excretion is below 700 mg, may increase by 500 mg every 4 weeks as tolerated
- Max: 2 g/day
Note: Therapy should not be started until an
acute gouty attack has subsided
Conjunction with penicillin
- Recommended dose: 2000 mg/day PO in divided doses
- Reduce dose in patient with renal impairment
Uncomplicated gonococcal infections
- 1 g PO with 4.8 million units of aqueous procaine penicillin IM; alt 3 g PO amoxicillin; alt 3.5 g PO ampicillin
Pediatric Dosing
Conjunction with penicillin
2-14 yrs of age
- Initial dose: 25 mg/kg body weight
- Maintenance dose: 40 mg/kg/day PO qid
- Children weighing above 50 kg may receive adult dose
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 10-50 mL/min: Avoid use
- Avoid use of penicillins when renal impairment
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Additional colchicine or other appropriate therapy is advisable if symptoms of gout exacerbate following therapy with probenecid
- Methotrexate dose should be reduced when administered with probenecid, as probenecid increases plasma concentrations of methotrexate resulting in methotrexate toxicity
- Use of salicylates is contraindicated in patients on probenecid therapy as it antagonizes the uricosuric action of probenecid. Use of acetaminophen would be preferred instead of salicylates
- Severe allergic reactions and anaphylaxis can occur with probenecid. Discontinue therapy if any signs of allergic reaction appear
- Hematuria, renal colic, costovertebral pain, and formation of uric acid stones have been associated with the use of probenecid and colchicine therapy in gouty patients. This can be prevented by alkalization of the urine and liberal fluid intake. Monitor acid base balance in these patients
- A reducing substance may appear in the urine of patients; suspected glycosuria should be confirmed by glucose test
- Probenecid will not be effective in chronic renal insufficiency with glomerular filtration rate 30 mL/minute or less
Cautions: Use cautiously in
- Renal impairment
- Peptic ulcer
Pregnancy Category:B
Breastfeeding: Limited data indicates that low level of probenecid is secreted in milk following maternal doses of up to 2 grams daily and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is >2 months old. The implications of enhanced excretion of drugs given with probenecid for nursing mothers and their infants has not been studied; however, only a few drugs are known to undergo active transport into breastmilk. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 13 June 2011).
