GOUT FAST FACT

Gout rarely affects children or young adults.

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Gout Treatment and Uric Acid Therapy

Before initiating a uric acid-reducing therapy, review the patient’s current medications to determine whether any might be contributing to the hyperuricemia. Potential offending drugs, especially thiazide diuretics, should be replaced with alternatives if possible. Low does aspirin, niacin, cyclosporin and tacrolimus are other medications known to raise uric acid.

Gout treatments to relieve pain and reduce swelling

The earlier in a gout flare therapy starts, the faster it will resolve.

Colchicine

Oral cochicine is most effective when taken within the first 12 hours of an acute attack by prescribing two 1.2 mg. tablets at first, followed by a third tablet one hour later and then three times per day for one week. Occasional side effects including nausea, vomiting, abdominal cramps or diarrhea are seen less at this dose.

Example: Colcrys

Glucocorticosteriods

Taken orally or injected into the affected joint or intramuscular injection, this treatment suppresses the inflammation of an acute gout attack.

Example: Medrol, Deltasone, Kenalog

Nonsteroidal anti-inflammatory drugs (NSAIDS)

Taken orally, NSAIDS such as ibuprofen, naprosyn, sulindac and indocin reduce the inflammation caused by deposits of uric acid in the body.

Examples: Aleve, Advil, Celebrex, Indocin, Motrin, Naprosyn

Treatments to lower uric acid levels and prevent future attacks

Allopurinol

Taken orally, Allopurinol decreases the body’s production of uric acid and is recommended for patients with a history of kidney stones or tophi.

Examples: Lopurin, Zyloprim

Febuxostat

Febuxostat is a medication that helps prevent uric acid production by blocking an enzyme that breaks down purines into uric acid. It can be taken by people with mild to moderate kidney or liver disease.

Example: Uloric

Pegloticase

Pegloticase is an infusible biologic. It is a recombinant uricase enzyme with a polyethylene glycol coating to decrease immunogenicity. The uricase enzyme breaks down uric acid to a more soluble, easy-to-eliminate compound.

Example: Krystexxa

Probenecid

Taken orally, this medication increases the kidneys’ ability to remove uric acid from the body. It is not recommended if there is a history of kidney stones or renal impairment.

Examples: Benemid, Probalan

New uric acid treatment options are in the research pipeline and may be available through participation in a clinical trial. For more information about factors to consider and a list of clinical trials currently enrolling patients, click here.

Brand names are registered trademarks of their respective owners.

Urate Lowering Therapies – These are life long therapies
Name	Dosage	Special Instructions	Possible Side Effects	Be Aware
Allopurinol Lopurin, Zyloprim	100 to 800 mg per day in a single dose. The dose is started and adjusted by 100 mg every two to four weeks to achieve a serum uric acid level lower than 6.0/dL.	Take immediately after a meal. Stop taking medication at the first sign of a rash, which may indicate an allergic or hypersensitivity reaction. May need to give as BID in doses over 300 mg/day to avoid nausea.	Rash, hives or itching; nausea; transaminase elevation, rare severe cutaneous reactions occur in approximately 1 in 250-300 patient starts.	Never start or stop allopurinol during a gout attack. Minimize attacks by initially prescribing lower doses along with colchicine or NSAIDs and until goal of a uric acid level of ≤ 6.0 mg. is reached. Caution with azothioprine, 6-mercaptopurine and theophylline.
Febuxostat Uloric	40 mg per day initially then increase to 80 mg per day in two weeks if serum uric acid level not lower than 6.0 mg.	Take any time of day without regard to food or antacid use.	Elevated liver enzymes (liver irritation); nausea; joint pain; rash.	Never start or stop febuxostat during a gout attack. Minimize attacks by prescribing colchicine or NSAIDs at the time of initiating treatment and until goal of a uric acid level of ≤ 6.0 mg. is reached. Contraindicated with azothioprine, 6-mercaptopurine and theophylline.
Pegloticase Krystexxa	8 mgs given IV every 2 weeks	For use in difficult to control hyperuricemia and chronic gout.	Infusion reactions including fever, nausea and hypotension.	This drug should be given in a monitored infusion center.
Probenecid Benemid, Probalan	500 to 3,000 mg per day in two or three divided doses.	Take with food or an antacid. Drink plenty of fluids. Do not take with aspirin or other NSAIDs. Avoid alcohol.	Headache; loss of appetite; nausea or vomiting.	Ineffective in patients with GFR less than 50. Should not be used with history of kidney stones.
Probenecid and colchicine ColBenemid, Col-Probenecid, Proben-C	One tablet (contains 500 mg probenecid and 0.5 mg colchicine) twice per day.	Take with food or an antacid. Drink plenty of fluids. Do not take with aspirin or other NSAIDs. Avoid alcohol.	Diarrhea; headache; loss of appetite; nausea or vomiting; stomach pain; rash.	Ineffective in patients with GFR less than 50. Should not be used with history of kidney stones.

Therapies to Relieve Pain and Reduce Swelling of Acute Gout
Name	Dosage	Special Instructions	Possible Side Effects	Be Aware
Colchicine Colcrys	Two tablets (1.2 mg) immediately then one tablet (0.6 mg) after one hour. Then one tablet twice or three times daily for one week.	Take with food if stomach upset occurs. Drink plenty of fluids.	Diarrhea; nausea or vomiting; stomach pain.	High dose colchicine for acute flares is inappropriate. Colchicine should be used with caution in people with renal disease and those with bone marrow suppression.
Glucocorticosteroids Methylprednisolone (Medrol);Prednisone (Deltasone); Triamcinolone (Kenalog)	Kenalog 60 mgs x1, followed by low dose steroids or oral predisone given at 30 mg with a taper to 0 mg over 10 days		Retention of sodium (salt) and fluids; weight gain; high blood pressure; loss of potassium; poor glucose control; and headache.	Particularly useful for those with chronic kidney disease. Use with caution in diabetic patients.
Nonsteroidal anti-inflammatory drugs (NSAIDs) Celecoxib (Celebrex); Ibuprofen (Advil); Indomethacin (Indocin); Naproxen (Aleve, Naprosyn).	High dose of any non-steroidals given for first 3 days, followed by moderate doses for an additional 7 days.		Nausea; stomach discomfort; retention of sodium; and fluids; dyspepsia; gastric ulcers; and headache.	May interact with blood pressure and heart medications, especially in the elderly. Use caution in patients with a history of GI ulcers, kidney disease and the elderly.
Anti-Inflammatory Prophylaxis for Prevention of Gout Flares
Name	Dosage	Special Instructions	Possible Side Effects	Be Aware
Colchicine Colcrys	One or two tablets (0.6 mgs) per day. 1.2 mgs maximum per day. Patients with severe kidney disease may only need one tablet every other day or every third day, depending on creatinine clearance.	Take with food if stomach upset occurs. Drink plenty of fluids.	Diarrhea; nausea or vomiting; stomach pain.	Some people are very sensitive to colchicine. If diarrhea or abdominal pains occur, dosage should be reduced.
Nonsteroidal anti-inflammatory drugs (NSAIDs)	Low dose of any non-steroidals may be used prophylactically following the first six months of urate lowering therapy.		Nausea; stomach discomfort; retention of sodium; and fluids; dyspepsia; gastric ulcers; and headache.	May interact with blood pressure and heart medications, especially in the elderly. Use caution in patients with a history of GI ulcers, kidney disease and the elderly. Ulcers may occur without any preceding symptoms.