From the Guidelines
The recommended duration of indomethacin treatment for acute gout is 7-10 days or until symptoms resolve. According to the American College of Physicians guideline 1, high-quality evidence showed that corticosteroids, NSAIDs, and colchicine are effective treatments to reduce pain in patients with acute gout. The guideline suggests that NSAIDs like indomethacin should be started at the first sign of an attack and continued until symptoms resolve. The 2016 updated EULAR evidence-based recommendations for the management of gout also support the use of NSAIDs, including indomethacin, as a first-line option for acute flares 1.
Some key points to consider when treating acute gout with indomethacin include:
- Starting treatment at the first sign of an attack
- Using a dose of 50mg three times daily
- Continuing treatment for 7-10 days or until symptoms resolve
- Avoiding use in patients with contraindications, such as renal disease, heart failure, or cirrhosis
- Monitoring for adverse effects, such as dyspepsia and potential gastrointestinal perforations, ulcers, and bleeding
It's also important to note that colchicine and corticosteroids are alternative treatment options for acute gout, and the choice of treatment should be based on the presence of contraindications, the patient's previous experience with treatments, and the number and type of joint(s) involved 1. Additionally, lifestyle modifications, such as weight loss, avoidance of alcohol and purine-rich foods, and regular exercise, can help reduce the risk of future gout attacks 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment of Acute Gout
The recommended treatment for acute gout includes non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids 2, 3, 4, 5, 6. These options are equally efficacious, and the choice of treatment is guided by comorbidities.
Indomethacin Treatment Duration
- The study by 3 compared triamcinolone acetonide with indomethacin in the treatment of acute gouty arthritis and found that resolution of all symptoms occurred at an average of 8 days for the indomethacin patients.
- However, the exact duration of indomethacin treatment is not explicitly stated in the provided studies.
- It is essential to note that treatment with NSAIDs, including indomethacin, should be initiated as soon as possible after the onset of acute gout symptoms and continued until the symptoms resolve, usually within 7-10 days.
Other Treatment Options
- Colchicine is an effective treatment for acute gout, with low-dose colchicine demonstrating a comparable tolerability profile to placebo and a significantly lower side effect profile to high-dose colchicine 5.
- Corticosteroids, such as triamcinolone acetonide, are also effective in treating acute gout, particularly in patients with contraindications to NSAIDs 3.
- IL-1β inhibitors, such as canakinumab, are highly effective for arresting flares but are considered salvage therapies due to their cost-effectiveness 6.