Probenecid

Sounds like 'pro-ben-eh-sid'

Key points about probenecid acid

  • Probenecid is used to prevent gout.
  • It belongs to a group of medicines known as urate lowering therapy.
  • Find out how to take it safely and possible side effects.
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Probenecid is used in adults to prevent gout attacks or flares. It's used when allopurinol can't be taken or hasn’t worked well. Sometimes probenecid is used with allopurinol.

Probenecid isn't a treatment for a gout flare — it doesn't relieve short-term pain and swelling. If you get an attack and are already taking probenecid you must keep taking the probenecid (see special instructions below).

How does probenecid work?

  • Probenecid helps your kidneys remove uric acid from your body. Uric acid is produced in your body when you digest and metabolise some types of food and drinks.
  • Usually excess uric acid is passed out in urine, but when uric acid levels are too high, the extra uric acid can turn into crystals in your joints, causing pain and swelling. This is known as gout. 
  • With each new attack, the size and number of crystals grow and can sometimes be seen as lumps under the skin (tophi). Over time this can damage your joints, bones and kidneys.

To reduce gout attacks, it's important to keep your uric acid level below 0.36 mmol/L

  • When your uric acid is below 0.36 mmol/L, no new crystals can form and crystals that are already in your joints can start to dissolve.
  • The risk of gout attacks and joint damage is reduced.
  • If you already have tophi, the goal is to get to a uric acid level below 0.3 mmol/L.
  • Uric acid levels can be checked with a blood test, which can be done at a blood lab, at your doctors clinic or at some pharmacies.

Read more about gout.

In Aotearoa New Zealand probenecid is available as 500 mg tablets. 

  • The dose of probenecid will be different for different people.
  • Your  healthcare provider will usually start you on a low dose of 250 mg (half a tablet) twice a day for 1 week, and increase it slowly over a few weeks. 
  • Your healthcare provider will check your uric acid level with a blood test and increase your probenecid dose until your uric acid level is less than 0.36 mmol/L.
  • The maximum dose is 1 gram twice daily.
  • Always take your probenecid exactly as your healthcare provider has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions.
  • Probenecid takes 2 to 3 months to become fully effective.

  • Timing: Take probenecid twice a day with a full glass of water. It's important to drink plenty of water while you're taking probenecid because kidney stones can develop if you don't drink enough fluid.  
  • Food: Take probenecid with food to prevent stomach upset.
  • Missed dose: If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the usual time. Don't take double the dose. If you are not sure what to do, ask your healthcare provider.
  • It's important to take it as prescribed: See tips to help you remember to take your medicines regularly.

Here are some things to know when you're taking probenecid. Other things may be important as well, so ask your healthcare provider what you should know about.

  • Alcohol: Limit or avoid drinking alcohol; it can increase your risk of gout flares.
  • Other medicines:
    • Probenecid  interacts with some medications, especially over-the-counter anti-inflammatories, such as diclofenac (e.g. Voltaren®), ibuprofen (e.g. Nurofen®), or aspirin (e.g. Disprin®, in doses used for pain relief). These can also be found in some cold and flu medicines (e.g. Nurofen Cold and Flu®). low-dose aspirin (e.g. Cartia®).
    • It may also interact with herbal supplements, rongoā Māori and medicines that are available without a prescription such as cough or cold and flu medication. Check with your pharmacist before taking any new medicines.
  • Keep yourself hydrated: probenecid can increase your chance of getting kidney stones. Drink at least 6 to 8 full glasses of water a day while taking probenecid to prevent kidney stones, unless directed to do otherwise by your healthcare provider.
  • Increased gout attacks: when you start taking probenecid, gout attacks can still happen in the first few weeks or months. When you start probenecid, your healthcare provider will also prescribe a low-dose non-steroidal anti-inflammatory (NSAID) or colchicine for 6 months to reduce the chances of these attacks. Keep taking probenecid every day, even during a gout attack.
  • Blood tests: When you first start taking probenecid, you'll need to have blood tests to monitor your uric acid levels every 4 weeks until the target level has been reached. Then you'll need blood tests 3-6 monthly to check uric acid levels and your kidney function. As your uric acid level decreases over time you're less likely to get gout flares. Keeping your uric acid level below 0.36 mmol/L, will help stop your gout attacks.
  • Pregnancy or breastfeeding: Talk to your healthcare provider if you're pregnant, planning a pregnancy or want to breastfeed.
  • Keep taking probenecid regularly: Treatment with probenecid is usually long-term. You should continue to take it every day, even during a gout attack. Probenecid takes 2 to 3 months to become fully effective.
  • Don’t stop taking probenecid suddenly: Talk to your healthcare provider before stopping. Stopping probenecid quickly can make your gout worse.

Like all medicines, probenecid can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • Feeling sick (nausea)
  • Upset stomach
  • Indigestion
  • Being sick (vomiting)
  • These are common common when you first start taking probencid, and usually go away with time.
  • Try taking probenecid with food.
  • Tell your doctor if these bother you.
  • Headache or dizziness
  • Loss of appetite
  • Flushing
  • These are less common.
  • Tell your doctor if these bother you.
  • Signs an allergic reaction such as skin rashes, itching, blisters, peeling skin, swelling of the face, lips, mouth or have problems breathing


  • This is rare.
  • Tell your doctor immediately or ring Healthline 0800 611 116.
  • Signs of problems with your kidneys such as passing urine more often than usual, pain when passing urine, blood in your urine, severe back pain.
 
  • Tell your doctor immediately or ring Healthline 0800 611 116.


Read more about medicines and side effects and reporting a reaction you think might be a side effect

The following links have more information on probenecid.
Probenecid(external link) New Zealand Formulary Patient Information te reo Māori(external link)

For healthcare providers

Gout Guide(external link) Tools and resources to improve gout outcomes Healthify He Puna Waiora, NZ, 2024

Brochures

Medicines and side effects(external link) Healthify He Puna Waiora, NZ, 2024
5 questions to ask about your medications(external link) Health Quality and Safety Commission, NZ, 2019 English(external link), te reo Māori(external link)

Apps

Medication reminder apps

References

  1. Managing gout in primary care(external link) BPAC, 2021
  2. Probenecid(external link) New Zealand Formulary
  3. Probenecid(external link) Medsafe datasheet, NZ 
  4. Medicines for gout(external link) Medsafe, NZ, 2021 
  5. Pharmacokinetic medicines interactions with probenecid(external link) Christchurch Medicines Information Service, NZ, 2022

Brochures

Medicines and side effects
Healthify He Puna Waiora, NZ, 2024

5 questions to ask about your medications

5 questions to ask about your medications

Health Quality and Safety Commission, NZ, 2019 English, te reo Māori

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Stephanie Yee, Pharmacist, Auckland

Last reviewed: