What are NSAIDs?
Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications that reduce pain, inflammation, and fever. They work by blocking the production of prostaglandins, which are chemicals in the body that contribute to inflammation. One important thing to remember for proper gout management: NSAIDs do not lower uric acid in the body.
NSAIDs are available over the counter or by prescription, depending on medication strength. Common NSAIDs include aspirin (Bayer®), ibuprofen (Advil®, Motrin®), and naproxen (Aleve®).
What are NSAIDs For?
Non-steroidal anti-inflammatory drugs, or NSAIDs, are used to treat the pain and inflammation that come with acute gout attacks. But what’s the difference between these anti-inflammatories and colchicine?
It is important to understand the relationship between NSAIDs and gout to help you make the most informed decision when you’re experiencing a flare.
What are the Best NSAIDs for Gout?
Ibuprofen and Naproxen are common over-the-counter NSAIDs for gout. Prescription-strength NSAIDs like indomethacin or celecoxib may also be used, often in higher doses for a shorter period.
Although acetylsalicylic acid (aspirin) is an NSAID, it’s not well-suited for treating gout, as studies show that low doses of acetylsalicylic acid can actually increase the risk of a gout attack.
Why Should You Recommend NSAIDs for Gout Treatment?
There are readily available over-the-counter NSAIDs for gout that are cost-effective. In fact, gout patients might already have a bottle in their medicine cabinet, as NSAIDs are used to treat all kinds of conditions, including headache and fever.
Compared to colchicine, which is only available via prescription, NSAIDs also have fewer side effects, work faster for some patients, and have a lower risk of toxicity.
What to Know About NSAIDs
NSAIDs are most effective when taken at the beginning of an attack, ideally within the first 24 hours. They are also used to quickly relieve the pain and swelling of an acute gout flare.
Dosage amounts depend on the type of NSAID being used. For example:
- 800 milligrams of ibuprofen should be taken three to four times daily.
- Indomethacin at 25-50 milligrams should be taken four times daily.
- Naproxen doses start at 750 milligrams, then 250 milligrams every eight hours until the flare has passed.
Talk to your physician to find which dose is right for you. Check warning labels to make sure you don’t go over the recommended dosing guidelines. Treatment should be active until the gout flare resolves, per Johns Hopkins Rheumatology.
Those with kidney disease or renal insufficiency should not use NSAIDs due to their possible negative impact on renal function, per guidance from the Gout Education Society. In these cases, alternative options should be considered.
Do NSAIDs Have Side Effects?
Yes, there are side effects to using NSAIDs for gout treatment. Common side effects include stomach and bowel problems, such as stomach pain, diarrhea, and nausea. Other side effects include high blood pressure and liver and kidney problems.
Can NSAIDs be Taken with Other Drugs?
Like any medication, NSAIDs do have some effect when used with other drugs. Always consult a doctor before combining NSAIDs with other medications, including other NSAIDs, blood thinners, and high blood pressure drugs.
NSAIDs can cause kidney failure when they are combined with ACE inhibitors (medications used to treat heart problems and high blood pressure) and diuretics (medications that remove excess fluid). Additionally, NSAIDs can oppose the effects of heart failure and high blood pressure medications and stop them from working effectively, including ACE inhibitors, beta blockers, and diuretics.
In Summary
NSAIDs play a role in managing the pain and inflammation of acute gout flares. While they don’t lower uric acid levels, their accessibility, effectiveness, and relatively mild side effect profile make them a go-to option for many patients.
Understanding how and when to use NSAIDs and knowing when to seek alternatives can help you navigate gout flares more confidently and safely. Always consult your healthcare provider to determine the best treatment plan for your individual needs.
