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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.

In general medications for acute treatment will reduce inflammation and pain.

  • Medications include colchicine, corticosteroids, and nonsteroidal anti-inflammatory drugs.
  • Allopurinol may also be used during a severe acute episode to reduce uric acid production.

Some medications for prevention may treat chronic inflammation, but most of them are given to reduce uric acid.

  • They will be considered if you have 2 or more attacks per year, skin lesions (tophi or subcutaneous nodules), a uric acid kidney stone, or reduced kidney function.
  • Medications include colchicine, nonsteroidal anti-inflammatory drugs, xanthine oxidase inhibitors, uricosuric medications, and pegloticase.

The choice and duration of medication will depend on many things, including your age, severity of disease and the number of joints affected, previous responses to treatment, overall health, and ability to tolerate the medication.

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.

Colchicine

Corticosteroids

  • Prednisone
  • Prednisolone

Xanthine Oxidase Inhibitors

  • Allopurinol
  • Febuxostat

Uricosuric medications

  • Probenecid
  • Sulfinpyrazone
  • Benzbromarone

Pegloticase

  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
  • 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. Febuxostat may be given if you cannot tolerate allopurinol or have kidney disease.

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)
  • Severe rash from allergic reaction
  • Ringing or buzzing in the ear—tinnitus (sulfinpyrazone)
  • Flare-up of peptic ulcer (sulfinpyrazone)
Pegloticase

Pegloticase has been approved by the US Food and Drug Administration (FDA) to treat adults who have severe gout that has not been relieved by other treatments. This medication is an enzyme that 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
  • Runny nose

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.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.

Revision Information

  • Allopurinol. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T233240/Allopurinol. Updated February 6, 2017. Accessed February 24, 2017.

  • Colchicine. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T233251/Colchicine. Updated February 6, 2017. Accessed February 24, 2017.

  • Febuxostat. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T589618/Febuxostat. Updated September 27, 2016. Accessed February 24, 2017.

  • Gout. American College of Rheumatology website. Available at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout. Updated April 2015. Accessed February 24, 2017.

  • Gout. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115215/Gout. Updated September 2, 2016. Accessed February 24, 2017.

  • Gout management—prevention of recurrent attacks. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T474277/Gout-management-prevention-of-recurrent-attacks. Updated November 4, 2016. Accessed February 24, 2017.

  • Gout management—treatment of acute attack. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T474276/Gout-management-treatment-of-acute-attack. Updated October 13, 2014. Accessed February 24, 2017.

  • Gout treatment. Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/types/gout/treatment.php. Accessed February 24, 2017.

  • Pegloticase. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T900694/Pegloticase. Updated February 6, 2017. Accessed February 24, 2017.

  • Probenecid. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T238042/Probenecid. Updated February 6, 2017. Accessed February 24, 2017.