How Does Selective Uric Acid Reabsorption Inhibitor (SURI) Work?

Selective uric acid reabsorption inhibitor (SURI) is a class of medication prescribed for excessive uric acid in the blood (hyperuricemia) associated with gout, a painful arthritic condition. Uric acid is a waste product from the metabolism of purine, an essential chemical in the body. SURI reduces blood uric acid levels by promoting its excretion in the urine.

Gout is caused by excess uric acid getting deposited as monosodium urate crystals in joints, bones, and soft tissues, which induces an immune reaction, leading to inflammation and associated symptoms. Gout most commonly affects the big toes, but can also affect other joints such as ankles, knees, elbows, wrists, and fingers.

Selective uric acid reabsorption inhibitor inhibits the activity of urate transporter URAT1 which is responsible for uric acid reabsorption in the kidneys. SURI also inhibits organic anion transporter 4 (OAT4), a uric acid transporter associated with diuretic-induced hyperuricemia.

Selective uric acid reabsorption inhibitor may be combined with a xanthine oxidase inhibitor, another class of medication commonly used to treat gout. Xanthine oxidase inhibitor reduces uric acid production by inhibiting the activity of xanthine oxidase, an enzyme that synthesizes uric acid from hypoxanthine, a purine derivative.

Currently, the selective uric acid reabsorption inhibitor is no longer available in the market because its production has been discontinued by the manufacturer.

Selective uric acid reabsorption inhibitor (SURI) is administered as oral tablets, approved by the FDA for use in the following conditions:

• Hyperuricemia
• Gout

Side effects of selective uric acid reabsorption inhibitor (SURI) may include the following:

• Headache
• Influenza
• Gastroesophageal reflux disease (GERD)
• Renal failure
• Elevation of blood creatinine
• Nephrolithiasis (kidney stones)
• Azotemia (elevation of blood urea nitrogen [BUN] and serum creatinine levels)
• Major adverse cardiovascular events such as:
  • Cardiovascular death
  • Nonfatal myocardial infarction (heart attack)
  • Nonfatal stroke
• An increase in liver enzymes ALT and AST
• Increase in blood alkaline phosphatase
• Hepatitis (liver inflammation)
• Hepatomegaly (liver enlargement)
• Hyperbilirubinemia (high bilirubin level in the blood)
• Cholestatic jaundice (jaundice from impaired bile flow)
• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Gastritis
• Dyspepsia (indigestion)
• Skin and subcutaneous reactions such as:
  • Rash
  • Maculopapular rash (flat lesions with raised bumps)
  • Urticaria (hives)
  • Pruritus (itching)
  • Erythema multiforme (round lesions like a bullseye)
  • Alopecia (hair loss)
  • Onycholysis (separation of the nail from the nail bed)
  • Bullous dermatitis (skin inflammation with blisters)
  • Exfoliative dermatitis (skin inflammation with redness and peeling of the skin)
  • Eczema
  • Lichen planus (an autoimmune inflammatory condition that can affect skin, nails, and mucus membrane in the mouth and genitals)
  • Leukocytoclastic vasculitis (small vessel inflammation in the skin)
  • Purpura (purple spots on the skin caused by small blood vessels bursting)
  • Toxic epidermal necrolysis (a severe skin condition with widespread redness, skin cell death, and exfoliation which can lead to sepsis)
  • Stevens-Johnson syndrome (a rare medical emergency with flu-like symptoms and a painful rash)
• Vasculitis (blood vessel inflammation)
• Necrotizing vasculitis (blood vessel wall tissue death)
• Ecchymosis (bruising)
• Eosinophilia (high level of eosinophils, a type of immune cells)
• Thrombocytopenia (decrease in platelet count)
• Increase or decrease in levels of leukocytes
• Pyrexia (fever)
• Myopathy (muscle diseases)
• Arthralgia (joint pain)
• Peripheral neuropathy (nerve damage)
• Neuritis (nerve inflammation)
• Paresthesia (prickling sensation)
• Somnolence (drowsiness)
• Ageusia (taste disorder)
• Epistaxis (nasal bleeding)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of the FDA-approved selective uric acid reabsorption inhibitor (SURI) and its combination with xanthine oxidase inhibitor include:

• Duzallo (DSC)
• lesinurad
• lesinurad/allopurinol
• Zurampic (DSC)