Medications for Treating Gout
Gout medicines ease pain and prevent future attacks.
In gout, excess uric acid in the blood forms sharp crystals in and around the joints. Painful attacks (also known as flares) come and go, often starting in the big toe.
Medications for gout have two purposes: to ease the pain and inflammation of acute attacks and to control uric acid levels to prevent future attacks. Some medications may be used only during attacks while others must be taken long term, even when you have no symptoms.
Here’s what you need to know about drugs used to treat gout.
Drugs for Pain and Inflammation
Colchicine is an oral anti-inflammatory prescribed for acute attacks or when beginning uric acid-lowering drugs.
Benefits and risks: Colchicine treats the pain and inflammation of acute attacks. It prevents gout flares when starting a medicine that lowers uric acid levels. You should not take colchicine if you have liver or kidney disease.
Side effects: Common side effects include diarrhea, nausea and abdominal cramps.
What else you need to know: Colchicine is most effective if taken at the first signs of a gout attack. It is available along with probenecid, a drug that helps the body eliminate uric acid, in a single pill under the trade name Col-Benemid.
Corticosteroids are powerful anti-inflammatory drugs that may be prescribed to control pain and inflammation of acute attacks.
Benefits and risks: Corticosteroids work rapidly to reduce inflammation and can be taken orally, injected systemically or directly into inflamed joints. They can cause serious health problems if used in high doses or for a long time. Frequent joint injections could lead to ligament and cartilage damage.
Side effects: Common side effects include increased appetite and weight gain, easy bruising, increased body hair and decreased resistance to infection.
What else you need to know: Injection of adrenocorticotropic hormone (ACTH), a synthetic drug that stimulates the body to produce corticosteroids naturally, can also help treat a gout attack.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are a large class of drugs used to relieve pain and inflammation. In gout, they are often given during acute attacks.
Benefits and risks: NSAIDs can help relieve the pain of an acute attack and shorten the attack, especially if taken in the first 24 hours. The most serious risks include stomach bleeding, kidney failure, and cardiovascular problems.
Side effects: Common side effects include nausea and vomiting, headache, diarrhea, dizziness, rash and drowsiness.
What else you need to know: NSAIDs may be prescribed along with a uric acid-lowering drug for the first 6 weeks to 12 months to prevent attacks.
Drugs for Lowering Uric Acid
Allpurinol is an oral medicine called an xanthine oxidase inhibitor (XOI), which reduces the body’s production of uric acid.
Benefits and risks: Allopurinol reduces how often gout attacks occur and makes them less severe. However, you may be at increased risk of an attack immediately after starting this drug. Taking allopurinol during an attack may actually make it worse. In rare cases, it can cause a severe allergic reaction.
Side effects: Occasional side effects include skin rash and stomach upset. Stomach problems usually go away as your body adjusts to the drug.
What else you need to know: Allopurinol is often prescribed at a low daily dose at first, with the dosage gradually increasing over time. It is also available along with lesinurad, another gout medication, in a single pill under the brand name Duzallo.
Febuxostat is an oral XOI that reduces the body’s production of uric acid.
Benefits and risks: Febuxostat can reduce how often attacks occur and make them less severe. You may experience a flare when you first start taking the drug. In rare cases, serious skin rashes occur.
Side effects: Common side effects include nausea, joint pain and muscle pain.
What else you need to know: If your gout flares while taking febuxostat, do not stop taking the drug. Contact your doctor. Don’t take febuxostat if you are taking azathioprine or mercaptopurine.
Lesinurad is an oral drug that helps the body eliminate uric acid. It is prescribed along with an XOI, such as allopurinol or febuxostat.
Benefits and risks: Lesinurad enhances the effects of XOIs to help control uric acid levels when an XOI alone is not sufficient. However, it may also increase cardiovascular risk.
Side effects: Possible side effects include headache, flu-like symptoms, increased blood creatinine, gastroesophageal reflux disease, kidney-related side effects and kidney stones.
What else you need to know: Stay well hydrated while taking lesinurad to avoid kidney stones. Lesinurad is also available with allopurinol in a single pill under the trade name Duzallo.
Pegloticase is given by intravenous infusion. It changes uric acid into a substance called allantoin that your body can eliminate easily. It is reserved for people in whom other gout medications have not worked.
Benefits and risks: Pegloticase is often effective in controlling gout when no other drugs do. Rarely, serious allergic reactions occur, usually within two hours of the infusion.
Side effects: Common side effects include gout flares or attacks, allergic reactions, nausea, bruising, sore throat, constipation, chest pain and vomiting.
What else you should know: Pegloticase is administered every two weeks at an infusion center. Your doctor may prescribe medicines before the infusion to reduce the risk of a negative reaction. You should not use any other drugs to lower uric acid while you are receiving pegloticase.
Probenecid is an oral drug that helps your kidneys eliminate uric acid.
Benefits and risks: Probenecid reduces gout attacks and their severity. However, it may increase the frequency of attacks the first 6 to 12 months you take it.
Side effects: Common side effects include kidney stones, nausea, skin rash, stomach upset and headaches.
What else you need to know: Probenecid is taken daily, even when you are not having symptoms. You should stay well hydrated to reduce the risk of kidney stones. Probenecid is also available along with colchicine in a single pill under the name Col-Benemid.
Take Gout Drugs Safely
Take these drugs exactly as prescribed. Follow special instructions – such as taking with plenty of water, avoiding alcohol while on the drug, or not taking with grapefruit juice. Not taking your gout medications consistently could result in gout flares. Never take colchicine for pain unrelated to gout.
Like all drugs, gout medications have the potential to cause side effects – some of them dangerous. Check with your doctor or pharmacist for a complete list of side effects for each medicine you are prescribed.
Let your doctor know if you don’t understand how or why you are taking any drug.