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Gout (cont.)

What Are Gout Treatments and Medications?

While some medications are used to treat the hot, swollen joint, other medications are used to prevent further attacks of gout. With any of these medications, an individual should call a doctor if he or she thinks they are not working or if he or she is having other problems with the medication.

Medicines used to treat acute gout and/or prevent further attacks are as follows:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Examples include indomethacin (Indocin), ibuprofen (Advil), and naproxen (Aleve). Newer drugs such as celecoxib (Celebrex) can also be used. Aspirin should not be used for this condition.
    • High doses of anti-inflammatory medications are used to control the inflammation and can be tapered off within a couple of weeks.
    • Tell a doctor about other health problems, particularly if one has a history of peptic ulcer disease or intestinal bleeding, if one is taking warfarin (Coumadin), or if one has problems with kidney function.
    • The primary complications of these medications include upset stomach, bleeding ulcers, and decreased kidney function.
  • Colchicine (Colcrys)
    • This medication is given in two different ways, either to treat the acute attack of arthritis or to prevent recurring attacks.
    • To treat the hot, swollen joint, colchicine is given rapidly (generally, two tablets at once followed by another tablet an hour later).
    • To help prevent an attack from coming back, colchicine can be given once or twice a day. While the chronic use of colchicine can reduce the attacks of gout, it does not prevent the accumulation of uric acid that can lead to joint damage even without attacks of hot, swollen joints.
    • Tell a doctor if experiencing any problems with kidney or liver function.
  • Corticosteroids
    • Corticosteroids such as prednisone (Meticorten, Sterapred, Sterapred DS) are generally given when a doctor feels this is a safer approach than using NSAIDs.
    • When given by mouth, high-dose corticosteroids are used initially and tapered off within a couple of weeks. It is important to take these medications as prescribed to avoid problems.
    • Some complications with the short-term use of corticosteroids include altered mood, elevated blood pressure, and problems with control of glucose in patients with diabetes.
    • Corticosteroids can also be injected into the swollen joint. Resting the joint temporarily, after it is injected with steroids, can be helpful.
    • Occasionally, corticosteroids or a related compound, corticotropin (ACTH), can also be injected into the muscle or given intravenously.

In addition to low-dose colchicine, other medicines used to prevent further attacks of gout and lower the level of uric acid in the blood include the following:

  • Probenecid (Benemid)
    • This medication helps the body eliminate excess uric acid through the kidneys and into the urine.
    • Individuals should drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming).
    • Advise a doctor if one has kidney problems or a history of kidney stones or if taking aspirin. One may need to take allopurinol (see below) instead.
    • There are a number of drug interactions with probenecid, so advise a doctor of other medications. If prescribed a new medication, let a doctor know that you are taking probenecid.
  • Allopurinol
    • This medication decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level. Allopurinol is currently the gold standard of maintenance therapy.
    • Advise your doctor if you have kidney problems. Allopurinol can be still used, but the dose may need to be adjusted.
    • Common side effects include stomach pain, headache, diarrhea, and rash.
    • Discontinue allopurinol if you develop a rash or a fever, and call your doctor.
    • A very rare risk of allopurinol hypersensitivity exists. This problem can cause a severe skin rash, fever, kidney failure, liver failure, bone marrow failure, and can be fatal.
    • Advise your doctor if you are taking azathioprine (Azasan, Imuran), 6-mercaptopurine, or cyclophosphamide (Cytoxan, Cytoxan Lyophilized, Neosar); dose adjustments of allopurinol may be needed.
    • Ampicillin (Principen) is more likely to cause a rash if you are taking allopurinol.
  • Febuxostat (Uloric)
    • Febuxostat is first new medication developed specifically for the control of gout in over 40 years.
    • Febuxostat decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.
    • Febuxostat can be used in patients with mild to moderate kidney impairment.
    • Febuxostat should not be taken with 6-mercaptopurine (6-MP), or azathioprine.
  • Pegloticase (Krystexxa)
    • Pegloticase is a PEGylated uric acid-specific enzyme given intravenously that is indicated for the treatment of chronic gout in adult patients refractory to conventional therapies described above.
    • Pegloticase should be avoided if you have G6PD enzyme deficiency.
    • Serious allergic reactions can occur with pegloticase, including life-threatening anaphylaxis.

It is important to understand that these maintenance medications are used to lower the uric acid well below normal to prevent recurrent gouty arthritis attacks. Generally, doctors want the blood uric acid level to be below 6.0 mg/dL. This level of uric acid is referred to as the "target level" or "goal" of therapy.

Last Reviewed 12/13/2017
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