Diuretic-Induced Gout — RACP Adult Medicine MCQ

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EasyClinical PharmacologyDiuretic-Induced GoutRACP Adult Medicine

A 70-year-old man on combination antihypertensive therapy (perindopril/amlodipine/indapamide) develops gout. Which of his antihypertensive agents is most likely to have precipitated the gout?

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Correct answer: A — Indapamide

Thiazide and thiazide-like diuretics (indapamide, hydrochlorothiazide) increase serum urate levels by reducing renal urate excretion through increased proximal tubular urate reabsorption (secondary to volume contraction) and competition for organic anion transporters. This can precipitate gout in susceptible individuals. Losartan (ARB) and amlodipine (CCB) have mild uricosuric properties and may be preferable in patients with gout. If a diuretic is essential, the urate-lowering effect of concurrent allopurinol can offset the diuretic-induced hyperuricaemia.

Reference: AMH – 2025 – Thiazide Diuretics; eTG – 2025 – Cardiovascular