Understanding your gout medication options can help you improve your quality of life while living with this disease. Below, you’ll learn about over-the-counter and prescription medications for gout that can minimize the disruption of gout flare-ups and, over time, cause flares to disappear.
Lowering Uric Acid Levels
Lowering uric acid levels to 6.0 mg/dL or lower is central to gout treatment. 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 starting on allopurinol for gout, your doctor will likely start you on a low dose (50 or 100 mg per day) and gradually increase the dose to between 200 and 800 mg per day until your serum uric acid is less than 6.0 mg/dL.
- Febuxostat – This is another potent form of urate-lowering therapy that can be prescribed under the brand name Uloric®. Its mechanism of action is similar to allopurinol and can be used in people who have difficulty taking allopurinol or who have active kidney or liver disease.
- 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.
Some 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 might start a patient on a low dose with a step-up plan to the optimal gout medication dose or use an alternative approach such as febuxostat.
Second-Line Urate Lowering Therapy
Most people with gout can get their disease under control using either allopurinol or febuxostat. Some patients, however, need additional therapy.
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.
These include:
Probenecid – Taken orally, this medication increases the kidneys’ ability to remove uric acid from the body and is used in combination with either allopurinol or febuxostat. It is not recommended if there is a history of kidney stones or renal impairment. It is marketed under the brand names Benemid® and Probalan®.
Pegloticase – Intravenously infused every two weeks, this biologic is helpful in advanced gout – also known as “uncontrolled gout.” It can rapidly reduce the size of tophi in the joints. It is prescribed under the brand name of Kystexxa®.
All of these urate-lowering therapy options are used with the goal of bringing uric acid under control. These uric acid-lowering drugs are generally considered a lifelong approach to managing the disease.
Pain Management
There are several options given that help get the pain from gout flares under control. These medications should be started as soon as possible and should be taken at least as long as the gout flare is active. It is important to take gout medications as prescribed to minimize side effects. If you experience 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 medications prescribed for pain and inflammation for gout are:
- Nonsteroidal anti-inflammatory drugs (NSAIDS) – Several (like Advil®, Aleve® and Motrin®) are available over-the-counter. Your doctor may also give you a prescription-strength dose. Other brand-name NSAIDs include Celebrex®, Indocin®, and Naprosyn®.
- Glucocorticosteroids – Cortisone can be taken orally, can be injected into the muscle, or can be injected directly into the inflamed joint. Regardless of the route taken, cortisone 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 0.6 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.
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