• Medications for Gout

    The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medicines only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
    Medicines are the primary treatment for gout. There are a number of medicines used to treat gout.
    Corticosteroids
    • Prednisone
    • Prednisolone
    • Apo-Prednisone
    Allopurinol
    • Zyloprim
    Uloric
    • Febuxostat
    Probenecid
    • Benemid
    Pegloticase
    • Krystexxa
      Nonsteroidal Anti-inflammatory Drugs
      • Ibuprofen (Apo-Ibuprofen)—OTC or prescription
      • Indomethacin (Indocin)—prescription only
      • Naproxen (Aleve)—OTC or prescription
      • Diclofenac (Cataflam)—prescription only

    Prescription Medications

    Colchicine
    Colchicine is given during a gout attack to relieve the pain, swelling, and inflammation. It works by decreasing the acidity of joint tissue and preventing deposits of uric acid crystals in joints. This medicine may also be taken in smaller doses to help prevent recurrent gout attacks. Colchicine is given either by mouth or by IV in a vein. When taken orally, it should be taken with food or liquids to help prevent stomach upset.
    Possible side effects include:
    • Diarrhea
    • Nausea
    • Vomiting
    • Abdominal pain
    • Kidney failure
    • Muscle pain
    • Peripheral nerve dysfunction
    Consult your doctor before taking colchicine if you:
    • Have a gastrointestinal disorder
    • Have a history of peptic ulcers or ulcerative colitis
    • Drink large amounts of alcohol
    • Have heart, liver, or kidney disease
    • Will have surgery within two months
    • Have a blood disorder
    Corticosteroids
    Common names include:
    • Prednisone
    • Prednisolone
    • Betametasone (for joint injection)
    • Triamcinalone (for joint injection)
    • Methylprednisolone (given IV, usually for severe cases)
    Corticosteroids can control the pain, swelling, and inflammation of joints caused by gout. The medicine can be given as a tablet or in liquid form or by injection into a joint—or in severe cases, by vein. If taken orally, corticosteroids are best taken at the same time(s) each day and should be taken with liquid or food to lessen stomach upset.
    Possible side effects include:
    • Acne
    • Poor wound healing
    • Indigestion, nausea, or vomiting
    • Diarrhea
    • Headache
    • Appetite gain or loss
    • Psychiatric disturbances
    • Weight gain
    • Severe side effects may include: Long term use may cause:
    Allopurinol
    Common names include:
    • Zyloprim
    Allopurinol is sometimes given to people who suffer repeated gout attacks, especially when tophi deposits, collections of uric acid crystals, develop. This medicine slows the development of uric acid by inhibiting the activity of certain enzymes. It is given in tablet form and should be taken at the same time (or times) each day with food or liquid to help avoid stomach upset.
    Possible side effects include:
    • Rash, which may progress to a life-threatening condition
    • Diarrhea
    • Nausea
    • Vasculitis (inflammation of blood vessels)
    • Bone marrow suppression
    • Liver or kidney problems
    Consult with your doctor before taking allopurinol if you:
    • Have an acute attack of gout
    • Have kidney or liver problems
    • Have Cancer
    • Use diuretics
    • Have an allergy to penicillin drugs
    • Have recently used immunosuppressive drugs
    Uloric
    Common name: Febuxostat
    This is the first new treatment for gout in more than 40 years. In clinical trials, uloric was more effective than allopurinol in lowering uric acid levels.
    Possible side effects include:
    • Liver function abnormalities
    • Nausea
    • Rash
    • Joint pain
    Probenecid
    Common name: Benemid
    Probenecid is sometimes given to patients who suffer repeated gout attacks (especially when tophi deposits develop). This medicine forces the kidneys to excrete additional uric acid. It is given in tablet form and should be taken at the same time each day with food or liquid to help avoid stomach upset.
    Possible side effects include:
    • Headache
    • Appetite loss
    • Nausea
    • Vomiting
    • Kidney disease (with prolonged use)
    • Kidney stones
    Consult your doctor before taking probenecid if you have:
    • An acute attack of gout
    • Kidney stones or kidney disease
    • Peptic ulcer
    • A blood disorder
    • Cancer
    Pegloticase
    Common brand name: Krystexxa
    Pegloticase has been approved by the Food and Drug Administration (FDA) to treat adults who have severe gout that has not been relieved by other treatments. This medicine works by turning uric acid into a chemical that does not cause gout symptoms. This chemical leaves the body through the urine. Pegloticase is given by injection every two weeks.
    Since severe allergic reactions are common with this medicine, a corticosteroid and an antihistamine are given before the injection of pegloticase. Other possible side effects include:
    • Flare-up of gout
    • Nausea and vomiting
    • Constipation
    • Bruise at the injection site
    • Nasal irritation
    • Chest pain
    The medicine has not been studied in people who have congestive heart failure .

    Prescription and Over-the-Counter Medications

    Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
    Common names include:
    • Ibuprofen (Apo-Ibuprofen)
    • Indomethacin (Indocin)
    • Naproxen (Aleve)
    • Diclofenac (Cataflam)
    NSAIDs are given to treat the pain, inflammation, and swelling caused by gout attacks. They can be purchased over-the-counter or your doctor may prescribe a higher dosage. They work by decreasing prostaglandins, hormones that produce inflammation and pain. The medicine may also be taken in smaller doses to help prevent attacks in patients with recurrent gout attacks. NSAIDs are given in tablet, capsule, or liquid form. They should be taken at the same time (or times) each day and should be taken with food or liquid to help avoid stomach upset.
    Possible side effects include:
    • Indigestion, ulcers, gastrointestinal bleeding, abdominal pain
    • Hives
    • Rash
    • Intense itching
    • Faintness
    • Nausea
    • Asthma
    • Heart disease
    Consult your healthcare provider before taking NSAIDs if you have:
    • Mental or neurological illness
    • Impaired liver or kidney function
    • High blood pressure or heart disease
    • History of stomach ulcers or reflux disease
    • Cardiovascular disease
    • Risk factors for cardiovascular disease like high blood pressure, diabetes, high cholesterol , smoking, or a family history of early heart attacks
    Corticosteroids and NSAIDS are equally effective for acute gout. But, corticosteroids may have fewer adverse effects.

    When to Contact Your Doctor

    Contact your doctor if:
    • You develop side effects from any medicine you take
    • Your symptoms worsen, do not improve, or keep coming back

    References

    American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .

    American College of Rheumatology website. Available at: http://www.rheumatology.org/ .

    Berkow R. The Merck Manual of Medical Information . New York, NY: Pocket; 2000.

    National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .

    7/19/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med. 2007;49:670-677. Epub 2007 Feb 5.

    9/17/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. FDA approves new drug for gout. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm225810.htm . Published September 14, 2010. Accessed September 17, 2010.

    Revision Information

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