52-year-old man with a history of hypertension has been taking lisinopril/hydrochlorothiazide for the past two years. He recently had his first episode of gout, followed by a recurrence three weeks later. Dietary factors have been reviewed; he drinks alcohol only rarely. Would stopping the diuretic be the first choice before instituting preventive therapy?—KATHLEEN CHAPMAN, MS, FNP, South Deerfield, Mass.
Stopping the thiazide would be appropriate, but initiation of therapy should begin at the same time. Cessation of a thiazide is rarely sufficient to completely prevent further occurrences of gout. Uric acid and creatinine levels should be checked before deciding which preventive therapy to begin.—Sherril Sego, FNP-C, DNP (145-1)