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.
Why do gout drugs focus on uric acid?
Uric acid is a waste product made by the body as it breaks down the purines found in foods. If uric acid builds up in the bloodstream, crystals may form. Those crystals may lodge in joint tissue, causing 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 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 kidneys and ultimately lead to kidney failure.
How is gout treated?
Before a medication can be prescribed, your doctor will need to determine whether your body overproduces uric acid or underexcretes it. 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 gout.
If your blood test shows too much uric acid, your body could be producing too much uric acid, or your kidneys may excrete it too slowly, causing it to build up in the bloodstream. You may be prescribed allopurinol (Lopurin, Zyloprim), which slows the production of uric acid and may dissolve crystals in tophi. If your kidneys don’t excrete uric acid fast enough, the drug probenecid (Benemid, Probalan) may be prescribed to help the kidneys increase production.
The drug colchicine is prescribed either instead of, or along with, allopurinol to prevent or relieve a gout attack. Used along with allopurinol in people who cannot tolerate NSAIDs or corticosteroids, colchicine reduces inflammation and prevents the buildup of uric acid crystals. In those who are allergic to allopurinol or who are in the throes of a gout attack, colchicine is an acceptable alternative.
Why can’t allopurinol be started or stopped during a gout attack?
Any fluctuation in uric acid level can bring on a gout attack. Starting, stopping and restarting allopurinol may cause enough of a fluctuation 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. Until allopurinol has had a chance to work long enough to eliminate the uric acid crystals (three to six months), another gout attack may occur. If it does, colchicine, an NSAID or a corticosteroid can be used to relieve pain and reduce inflammation.
Is it risky to take gout drugs?
No drug is completely risk free. That said not controlling the 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, there may be an increased risk of an allergic reaction triggered by the gout drugs allopurinol, colchicine or probenecid 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 blurry vision in the short term. NSAIDs, when used for a long time or in high doses, can irritate the lining of the stomach and intestines, causing pain or bleeding ulcers. And it’s possible that some NSAIDs may increase the risk of heart attack or stroke in some people.
Can I treat gout with diet and exercise, instead of medications?
Controlling gout with diet is an extremely important part of lifelong treatment. You can control how much uric acid your body produces by avoiding foods 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 moderate-purine foods, such as asparagus, beef, chicken, ham, mushrooms and shellfish.
Exercise also helps to bring down the level of blood sugar, 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 dramatically decrease painful gout attacks and prevent future ones, take your prescribed medication regularly, and follow your doctor’s diet and exercise recommendations.
Why does alcohol need to be avoided?
Alcohol disrupts the kidneys’ ability to filter uric acid out of the blood. Therefore, it can make gout symptoms worse. Consuming alcohol while taking gout medications, such as colchicine, NSAIDs or probenecid, may increase the risk or severity of the medication’s side effects.
