What are the over-the-counter (OTC) treatment options for a patient experiencing a gout attack?

From the Guidelines

Over-the-counter treatment options for a gout attack include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) at 400-800 mg three to four times daily or naproxen sodium (Aleve) at 220-440 mg twice daily, as recommended by the American College of Physicians 1. These medications should be taken with food to minimize stomach irritation and continued until the attack resolves, typically 3-7 days. Some key points to consider when treating a gout attack include:

• Topical ice application for 20 minutes several times daily can help reduce inflammation and pain.
• Drinking plenty of water (at least 8-10 glasses daily) helps flush uric acid from the body.
• Avoiding alcohol and purine-rich foods like red meat, seafood, and organ meats during an attack is also important.
• NSAIDs work by blocking enzymes that produce inflammation-causing prostaglandins, thereby reducing pain and swelling.
• Patients with kidney disease, heart conditions, stomach ulcers, or those taking blood thinners should avoid NSAIDs and consult a healthcare provider before self-treating.
• If symptoms don't improve within 48 hours or worsen, medical attention should be sought as prescription-strength medications may be necessary, as suggested by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. It's also important to note that colchicine is another option for treating gout attacks, and it's recommended to use low-dose colchicine when using colchicine to treat acute gout, as stated in the American College of Physicians guideline 1. Additionally, lifestyle modifications such as weight loss, regular exercise, and a diet low in purines and sugar-sweetened drinks can help prevent future gout attacks, as recommended by the EULAR guidelines 1.

From the FDA Drug Label

For treatment of gout flares in patients with mild (Cl cr 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine The efficacy of a low-dosage regimen of oral colchicine (total dose 1. 8 mg over one hour) for treatment of gout flares was assessed in a multicenter, randomized, double-blind, placebo-controlled, parallel group, one week, dose-comparison study.

OTC Treatment Options for Gout Attack:

• Colchicine: The FDA drug label for colchicine 2 and 2 provides information on its use for the treatment of gout flares. However, Colchicine is a prescription medication, not an over-the-counter (OTC) option.
• No OTC options are mentioned in the provided drug labels for the treatment of gout attacks.

From the Research

Over-the-Counter (OTC) Treatment Options for Gout Attack

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are the preferred treatment for acute gout attacks 3, 4
• NSAIDs can help reduce pain and inflammation, and the most important factor is how soon the treatment is initiated 3
• Examples of NSAIDs that can be used to treat gout attacks include naproxen 5
• Colchicine is another option for treating gout attacks, especially for patients who cannot take NSAIDs 3, 6, 5
• Topical ice and rest of the inflamed joint are also useful nonpharmacological treatments for acute gout attacks 3

Comparison of Treatment Options

• A study comparing naproxen and low-dose colchicine found no significant difference in pain intensity over 7 days, but naproxen caused fewer side effects 5
• Another study found that non-selective NSAIDs and selective cyclo-oxygenase-2 (COX-2) inhibitors are probably equally beneficial in terms of pain relief, but non-selective NSAIDs may increase withdrawals due to adverse events and total adverse events 4
• Systemic glucocorticoids and NSAIDs are probably equally beneficial in terms of pain relief, improvement in function, and treatment success, but NSAIDs may result in more total adverse events 4

Important Considerations

• It is essential to distinguish between therapy to reduce acute inflammation in acute gout and therapy to manage hyperuricaemia in patients with chronic gouty arthritis 3
• The treatment of acute gout attacks focuses on nonsteroidal anti-inflammatory drugs (NSAID), glucocorticoids, and colchicine, while long-term management involves uric acid-lowering treatment with xanthine oxidase inhibitors (e.g., allopurinol) 7
• Prophylaxis to prevent acute flares is crucial, especially during the first months of uric acid-lowering treatment 3, 7, 6