Medications used for gout differ depending on whether they are used to treat an acute attack of gout, or whether they are used to prevent future attacks.
Medications for acute gout attacks
The goal of treatment for acute gout attacks is fast pain relief. In addition to resting the affected joint and using ice to reduce swelling, the following medications may be used short-term, until the pain and inflammation subside.
If treatment is started right away, relief from symptoms often occurs within 24 hours.
Non-steroidal anti-inflammatory drugs (NSAIDs)
These medications reduce pain, swelling and redness (inflammation) quickly.
- Examples of commonly used NSAIDs are:
- Side effects:
- NSAIDs can cause tummy problems such as indigestion and nausea, and kidney problems.
- There is also a risk of stomach ulcers, high blood pressure and heart problems.
- Most people, however, find they tolerate NSAIDs well with good relief of their pain.
- Because of the risks associated with NSAIDs, your doctor will prescribe the lowest dose possible for a short length of time.
- Aspirin not recommended
- Although it is an NSAID, aspirin is not recommended for gout as it can actually increase the level of uric acid in your blood.
- Low doses of aspirin (100 mg daily), when prescribed for the prevention of heart attacks, should not increase your uric acid levels significantly, and should be continued.
If you cannot take NSAIDs and there is no infection, you may be given a corticosteroid.
- Can be given as:
- An injection into the joint.
- Tablets called prednisone which you take orally for 5 to 7 days.
- Side effects: Corticosteroids can cause mood changes, sleep problems and raised blood pressure and blood glucose.
Another option for treating an acute of gout is colchicine. This is usually reserved if you cannot take NSAIDs or prednisone.
- Use: Colchicine is also used to reduce gout flares while starting allopurinol, or other uric acid-lowering medicines.
- Side effects: Colchicine can cause unpleasant side effects such as nausea (feeling sick), vomiting (being sick) and diarrhoea (runny poos).
Preventing recurrent gout attacks
If you have repeated attacks of gout, your doctor may recommend preventive medication. This helps to prevent further attacks of gout and damage to your joints and organs such as your kidneys.
Because gout is caused by raised uric acid levels in the blood, preventive medications work by reducing uric acid levels. This is also called urate lowering therapy.
The goal of these medicines is to reduce the uric acid levels below 0.36mmol/L. If the uric acid level is kept at this level long-term, the gout crystals will dissolve, and the risk of gout attacks and joint damage from gout will gradually reduce. The options include:
Medications that block uric acid production
- Examples: allopurinol and febuxostat.
- How they work: These medications limit the amount of uric acid your body makes.
- Risks: Acute attacks or 'flares'
- Doctors sometimes delay the start of these medications for at least a week after the acute gout has settled because they may actually make a gout attack last longer, or trigger acute attacks (‘flares’ or ‘breakthrough’ attacks) at the start of treatment.
- To reduce the risk of such acute flares of gout your doctor may prescribe a small dose of colchicine, or an NSAID, for 3-6 months after starting treatment with allopurinol or febuxostat.
Medications that improve uric acid removal
- Example: probenecid.
- How it works:
- Probenecid improves your kidneys' ability to remove uric acid from your body.
- This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased, which may cause kidney stones.