If the blood test shows elevated uric acid levels, it could be that your body is producing too much uric acid, or that your kidneys may excrete it too slowly, causing it to build up in the bloodstream. Depending on what your tests show, you may be prescribed one of the following:

Allopurinol (Lopurin, Zyloprim). The most widely used medication for lowering uric acid levels, this slows the production of uric acid and may dissolve crystals in tophi. It can take three to six months to dissolve the uric acid crystals so that during that time, a gout attack may occur. In fact, starting, stopping, and restarting allopurinol may cause enough fluctuation of uric acid levels to trigger an attack. Also, as allopurinol starts to dissolve uric acid crystals in joints and tissues, the uric acid once again enters the bloodstream to be excreted. If another attack occurs, colchicine, an NSAID, or a corticosteroid can be used to relieve pain and reduce inflammation.

Doctors typically start patients on a low oral dose of allopurinol, increasing it as need every two to four weeks to establish safe levels of uric acid. It’s a good choice for patients who overproduce (versus underexcrete) uric acid, a determination your doctor will make through blood or urine tests. But it can have side effects such as skin rash, sleepiness, and stomach upset, and rarely, can cause a severe allergic reaction.

Probenecid (Benemid, Probalan). If your kidneys don’t excrete uric acid fast enough, your physician may prescribe this drug to increase the excretion. It has less dangerous side effects than allopurinol. However, it’s not recommended for those with kidney disease.

Febuxostat (Uloric). Taken orally, this drug helps prevent uric acid production by blocking an enzyme that breaks down purines into uric acid. Purines are the substances in animal proteins that convert to uric acid. It is safe for people with mild to moderate kidney or liver disease. Side effects may include liver irritation, nausea, joint pain, and rash. It carries a higher risk of blood clots than allopurinol.

Is it risky to take gout drugs?

No drug is risk free. But an uncontrolled level of uric acid in your body can have consequences too, such as high blood pressure or kidney problems. Treating gout is a lifelong task. However, the gout drugs allopurinol, colchicine or probenecid may increase risk of an allergic reaction if you already have congestive heart disease, high blood pressure, diabetes, kidney disease, stomach ulcers or other digestive tract problems, or cancer being treated by chemotherapy or radiation. And other drugs used to treat gout symptoms have possible side effects, too. For instance, corticosteroids – used to bring down inflammation quickly – can cause short-term blurry vision. NSAIDs, used for a long time or in high doses, can irritate the lining of the stomach and intestines, causing pain or bleeding ulcers. And some NSAIDs may increase the risk of heart attack or stroke, particular in people already at risk for those conditions.

Can I control gout with diet and exercise?

Controlling gout with diet is an important part of lifelong treatment. You can control the amount of uric acid your body produces by avoiding certain foods that are high in purines,  which increase the uric acid level when they are digested and metabolized. Such foods include alcohol, bacon, haddock, liver, scallops, turkey, veal and venison. Go light on foods moderately high in purines such as asparagus, beef, chicken, ham, mushrooms and shellfish.

Exercise also helps to bring down blood sugar levels as well as blood pressure. And it can spur weight loss. All of those actions – losing weight, reducing high blood pressure, and controlling blood sugar – help reduce the risk of developing gout.

To decrease painful gout attacks and prevent future ones, take your prescribed medication and follow your doctor’s diet and exercise recommendations.

Why do I have to avoid alcohol?

Alcohol disrupts the kidneys’ ability to filter uric acid out of the blood. And it’s dehydrating. Both of those effects can worsen gout symptoms. Consuming alcohol while taking gout medications such as colchicine, NSAIDs or probenecid may increase the risk or severity of the medication’s side effects.

See all gout drugs.