Understanding your gout medication options can help you improve your qualify of life while living with this disease. Below you’ll learn about over-the-counter and prescription gout meds that can minimize the disruption of gout flare-ups.
Lowering Uric Acid Levels
Standard urate-lowering gout medications are:
- Allopurinol – This is an oral prescription medication that helps lower serum uric acid levels. This medicine is also known by brand names Lopurin® and Zyloprim®. When started on this drug, your doctor will likely start you on a low dose (50 or 100 mg per day) and gradually increase the dosage to a standard prescription dose until your serum uric acid is less than 6 mg/dL.
- Febuxostat – This is another urate-lowering therapy that can be prescribed under the brand name Uloric®. This medication is taken orally and decreases the body’s production of uric acid. It can be taken by people with mild to moderate kidney or liver disease.
Some general potential side effects of allopurinol are: changes in taste, diarrhea, indigestion and stomach pain or cramps (all observed in less than 3% of users). For febuxostat, some minor side effects are: changes in appetite, constipation or diarrhea, nausea, hot flush to face or skin, stomach upset or pain. It’s important that if they persist or there are questions, call a doctor.
Though only 1 in 1,000 patient cases, there is a more severe hypersensitivity reaction to allopurinol, with fever or rash that can cover the body and deterioration of liver and kidney function. At-risk patient populations (Han Chinese, Southeast Asians, African-Americans and Koreans with kidney disease) can be screened for a genetic marker (HLA-B5801) that can predict this reaction. To alleviate this hypersensitivity, doctors will start a patient on a low dose with a step-up plan to the optimal gout medication dose.
Recurring Gout Medications
When first-line gout therapy with either allopurinol or febuxostat is not adequate to lower your serum uric acid level to less than 6.0 mg/dL, your doctor may increase gout medication dosage, add another medication to the traditional therapy or add a second uric acid-lowering medication that works differently than either allopurinol or febuxostat. This medication is probenecid. All of this is done with the goal of bringing uric acid under control—because ongoing flares result from higher sUA levels, and as the culprit in this disease, uric acid has to be reduced to stop flares.
When standard-of-care medications like allopurinol aren’t working, others will be introduced at this stage of gout disease. They are:
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. Two brand names are Benemid® and Probalan®.
Pain Management
There are several options given that help get the pain under control. By mouth, these medications are typically taken as long as the gout flare lasts. It is important to take gout medications as prescribed to minimize side effects. If experiencing stomach upset when taking medications, your doctor, or other health provider, will guide you on taking your medication with food or switching to another medication.
Standard medicines prescribed for pain and inflammation for gout are:
- Nonsteroidal anti-inflammatory drugs (NSAIDS) – Several (like Advil®, Aleve® and Motrin®) are available in over-the-counter dosing. Your doctor may also give you a prescription dose. Other brand-name NSAIDs include Celebrex®, Indocin®, Naprosyn® and Tivorbex®.
- Glucocorticosteroids – Cortisone can be taken orally or injected, and quickly suppresses the inflammation of an acute gout flare. It may be prescribed under the brand names Deltasone® (prednisone), Kenalog®-40 or Medrol®.
- Colchicine – This is usually most effective when taken within the first 12 hours of an acute flare. A common dosing schedule is to take two, 1.2 mg tablets at once, then a third tablet one hour later, followed by one tablet once or twice daily over the next week. Some people have abdominal cramping and diarrhea with this medication. Brand names include Colcrys® and Mitigare®.
It is important to note that gout flares often occur when a patient first starts taking their uric acid lowering medication. Patients can help prevent flares when starting these medications by also taking low‐dose colchicine or NSAIDs. Often, doctors advise patients to keep taking colchicine in a low, preventive dose for at least six months. The uric acid lowering drugs are generally regarded as life-long therapies.
If you are taking a uric acid-lowering drug, your doctor should slowly raise the dose and keep checking your blood uric acid levels regularly. Once your uric acid levels reach or drop below a healthy 6.0 mg/dL, crystals tend to dissolve and new deposits of crystals can be prevented
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