Drug Guide: Gout Medications

Gout medications are used to relieve acute pain and inflammation and reduce uric acid in the blood, thereby preventing recurrence of attacks.

By By Dorothy Foltz-Gray

The First Line of Defense

A gout attack is the result of a buildup of uric acid in the blood, which forms crystals in the joints. At the onset of a gout attack – characterized by an inflamed joints (usually the big toe), that’s reddened and warm to the touch, your doctor will give you one or more of the following medications to address pain and inflammation.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Your doctor may prescribe indomethancine (Indocin), ibuprofen (Advil) or naproxen sodium (Aleve), which can help relieve pain and inflammation within the first 24 hours after a gout attack. However, these can have side effects such as stomach upset or ulcer, or heart disease risk. People with gastrointestinal, kidney or heart problems should not take them.

Colchicine. This anti-inflammatory is most effective taken within 12 hours of an attack. It helps prevent the buildup of uric acid crystals in the joints Colchicine is sometimes taken in addition to NSAIDs for six to 13 months until uric acid levels are stabilized by other long-term medication. (See below.)

Corticosteroids. Corticosteroids, such as prednisone work by suppressing the inflammation of an acute attack, usually within 24 hours. When patients can’t tolerate NSAIDs or colchicine, corticosteroids may be injected into the painful joint. If a number of joints are involved, the medication may be injected into the muscle or taken orally. They can make it more difficult for people with diabetes to control their blood sugar, and they can cause temporarily blurry vision.

Long-Term Treatment

The goal of long-term treatment  is to reduce and stabilize the level of uric acid in your blood. Uric acid is a waste product made by the body as it breaks down purines – compounds found in foods, particularly those high in protein. If uric acid builds up in the bloodstream, crystals may form in joint tissue, triggering the pain and inflammation associated with gout attacks.

Over time, accumulated uric acid crystal deposits (called tophi) can damage tissues and lead to lumps under the skin, joint deformity, or can also accelerate degeneration in the joint that can lead to osteoarthritis. When uric acid is very high, gout can affect the kidneys. About 20 percent of people with gout develop kidney stones, which can damage the organs and ultimately lead to kidney failure.

Before a doctor can prescribe long-term medication, he will need to determine whether your body overproduces or underexcretes uric acid. You’ll be given a blood test to measure your level of uric acid. A high uric acid level means you have hyperuricemia; however, having hyperuricemia does not necessarily mean you have – or will develop – gout.

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.