From the Guidelines
Furosemide can exacerbate gout in patients, and its use should be carefully considered, with alternative diuretics like losartan or calcium channel blockers preferred if possible, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. When managing gout in patients on furosemide, it is essential to weigh the benefits of furosemide against the potential risk of worsening gout. Furosemide increases serum uric acid levels by enhancing reabsorption in the proximal tubule and reducing uric acid excretion, which can trigger or exacerbate gout attacks 1.
Key Considerations
- For patients with gout who require furosemide, consider using the lowest effective dose and adding a urate-lowering therapy (ULT) such as allopurinol or febuxostat, as recommended by the EULAR guidelines 1.
- During acute gout attacks, continue furosemide if medically necessary while treating the attack with colchicine, NSAIDs, or corticosteroids, following the EULAR guidelines for acute flare management 1.
- Encourage lifestyle modifications, including weight loss, limiting alcohol intake, avoiding high-purine foods, and maintaining adequate hydration, as supported by the EULAR guidelines 1.
- Regular monitoring of serum uric acid levels is crucial, aiming for levels below 6 mg/dL to prevent future attacks, as recommended by the EULAR guidelines 1.
Alternative Diuretics
If gout attacks are frequent or severe despite these measures, consider consulting with a rheumatologist about alternative diuretic options, such as losartan or calcium channel blockers, which do not raise uric acid levels, as suggested by the EULAR guidelines 1.
From the FDA Drug Label
Asymptomatic hyperuricemia can occur and gout may rarely be precipitated.
- Gout may be precipitated in patients taking furosemide due to asymptomatic hyperuricemia.
- The risk of gouty arthritis is increased when furosemide is used concomitantly with cyclosporine, secondary to furosemide-induced hyperuricemia and cyclosporine impairment of renal urate excretion 2.
- Patients taking furosemide should be monitored for signs of gout.
From the Research
Gout and Furosemide
- Furosemide, a diuretic, is known to increase the risk of gout in patients due to its effect on uric acid levels 3.
- The use of diuretics, including furosemide, is considered a risk factor for developing gout, particularly in patients with hypertension or chronic kidney disease 3, 4.
- Patients with gout who are taking furosemide may require closer monitoring of their uric acid levels and adjustment of their gout treatment regimen to prevent exacerbations 5, 6.
Treatment Considerations
- For patients with gout on furosemide, the treatment approach may involve a combination of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids for acute gout attacks, as well as urate-lowering therapy (ULT) for long-term management 5, 3, 6.
- The choice of ULT agent, such as allopurinol or febuxostat, may depend on the patient's renal function, presence of tophi, and other factors, with febuxostat potentially being a better option for long-term ULT in terms of medication adherence 7.
- A team approach to gout management, involving nephrologists, rheumatologists, and primary care physicians, may be necessary to optimize treatment outcomes for patients with gout on furosemide 4.