• Medications for Gout

    The information provided here is meant to give you a general idea about each of the medications 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 medications 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.
    Medications can be used to treat the symptoms of acute attacks and help prevent future recurrent attacks. Medications for acute attacks work best if taken within 24 hours of symptom onset. They may only be needed for a short time. Preventive medications will have to be taken on a regular basis.
    • Prednisone
    • Prednisolone
    • Allopurinol
    • Febuxostat
    • Probenecid
    • Sulfinpyrazone
    • Benzbromarone
    • Ibuprofen—over-the-counter (OTC) or prescription
    • Indomethacin—prescription only
    • Naproxen—OTC or prescription
    • Diclofenac—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 medication may also be taken in smaller doses to help prevent recurrent gout attacks when people are started on urate-lowering medications.
    Possible side effects include:
    • Diarrhea
    • Nausea
    • Vomiting
    • Abdominal pain
    • Muscle pain
    Consult your doctor before taking colchicine if you have liver or kidney disease.
    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 medication can be given as a tablet or in liquid form or by injection into a joint—or in severe cases, as an IV. 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:
    • Indigestion, nausea, or vomiting
    • Thrush
    • Diarrhea
    • Headache
    • Psychiatric disturbances
    • Weight gain
    • Long term use may cause:
    Xanthine Oxidase Inhibitors
    Common names include:
    • Allopurinol
    • Febuxostat
    Xanthine oxidase inhibitors are sometimes given to people who suffer repeated gout attacks. This medication slows the development of uric acid by inhibiting the activity of certain enzymes. It's given in tablet form and should be taken at the same time(s) each day. Allopurinol should be taken with food or liquid to help avoid stomach upset.
    Possible side effects include:
    • Rash
    • Nausea
    • Liver problems
    • Joint pain (febuxostat)
    Uricosuric Medications
    Common names include:
    • Probenecid
    • Sulfinpyrazone
    • Benzbromarone
    These medications are sometimes given to those who suffer repeated gout attacks (especially when tophi deposits develop). This medication forces the kidneys to excrete additional uric acid. It's given in tablet form and should be taken at the same time each day with food or liquid to help avoid stomach upset. People with uric acid kidney stones or with certain blood disorders should not take these medications.
    Possible side effects include:
    • Headache
    • Appetite loss
    • Nausea
    • Vomiting
    • Kidney stones
    • Lightheadedness (sulfinpyrazone)
    • Ringing or buzzing in the ear—tinnitus (sulfinpyrazone)
    • Flare-up of peptic ulcer (sulfinpyrazone)
    Pegloticase
    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 medication 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 2 weeks.
    Since severe allergic reactions are common with this medication, 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

    Prescription and Over-the-Counter Medications

    Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
    Common names include:
    • Ibuprofen—OTC or prescription
    • Indomethacin—prescription only
    • Naproxen—OTC or prescription
    • Diclofenac—prescription only
    NSAIDs are given to treat the pain, inflammation, and swelling caused by gout attacks. Some 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 medication may also be taken in smaller doses to help prevent attacks in those with recurrent gout attacks who are started on urate-lowering medications. NSAIDs are given by mouth. 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:
    • Stomach problems, such as stomach upset, ulcers, and bleeding
    • Worsening of chronic conditions, such as high blood pressure, heart failure, or kidney disease
    • Kidney damage
    • Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes
    • Increased risk of bleeding—always inform your doctor that you are taking an NSAID before having any medical or dental procedures or surgeries
    NSAIDs may cause an increased risk of serious cardiovascular problems, like heart attack and stroke. This risk is especially important for those with cardiovascular disease or who are have risk factors for cardiovascular disease.

    Special Considerations

    If you are taking medications, follow these general guidelines:
    • Take the medication as directed. Do not change the amount or the schedule.
    • Ask what side effects could occur. Report them to your doctor.
    • Talk to your doctor before you stop taking any prescription medication.
    • Plan ahead for refills if you need them.
    • Do not share your prescription medication with anyone.
    • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

    References

    ACR publishes guidelines for pharmacologic and nonpharmacologic treatment of gout. Am Fam Physician. 2013;88(6):408-412.

    Allopurinol. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 29, 2013. Accessed December 5, 2014.

    Febuxostat. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 13, 2013. Accessed December 5, 2014.

    Gout. American College of Rheumatology website. Available at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout. Updated September 2012. Accessed December 5, 2014.

    Gout. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 28, 2014. Accessed December 5, 2014.

    Gout—treatment of acute attack. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 13, 2014. Accessed December 5, 2014.

    Gout—prevention of recurrent attacks. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 3, 2014. Accessed December 5, 2014.

    Probenecid. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed December 5, 2014.

    7/19/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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(5):670-677.

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