What is a potential risk of starting probenecid during an acute gout attack?

Starting probenecid during an acute gout attack poses the risk of increased serum urate levels. Probenecid is a uricosuric agent, which works by increasing the excretion of uric acid from the body through the urine. However, when initiated during an acute gout attack, the medication can lead to a temporary spike in serum urate levels as uric acid is mobilized from tissues into the bloodstream before being excreted. This increase can exacerbate the symptoms of gout and prolong the attack, making it counterproductive to start treatment with probenecid in this context.

It’s important to manage acute gout with anti-inflammatory agents to reduce the ongoing inflammatory response effectively, rather than starting medications intended for long-term management of hyperuricemia.