From the Guidelines
Furosemide (Lasix) should be avoided in patients with gout whenever possible, as it can increase uric acid levels and trigger or worsen gout attacks, as suggested by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. When managing patients with gout, it is essential to consider the potential effects of diuretics like furosemide on uric acid levels.
- Furosemide can enhance the reabsorption of uric acid in the kidneys and reduce its excretion, leading to increased uric acid levels.
- This can trigger or worsen gout attacks, especially in patients with a history of frequent gout flares.
- The 2016 updated EULAR recommendations suggest substituting diuretics with alternative medications, such as losartan or calcium channel blockers, in patients with gout who require diuretic therapy 1.
- If furosemide is necessary, patients should be monitored closely for gout flares, and preventive measures such as adequate hydration and prophylactic medications like colchicine or allopurinol may be considered.
- Regular monitoring of uric acid levels is also advisable when using furosemide in patients with gout history. The benefits of avoiding furosemide in patients with gout often outweigh the potential risks, especially when alternative diuretics or medications are available.
- A study published in the Annals of the Rheumatic Diseases in 2017 found that substituting diuretics with alternative medications can help reduce the risk of gout flares and improve patient outcomes 1.
- Another study published in the same journal in 2006 also suggested that avoiding diuretics like furosemide can help reduce the risk of gout attacks and improve patient quality of life 1.
From the FDA Drug Label
Asymptomatic hyperuricemia can occur and gout may rarely be precipitated. Concomitant use of cyclosporine and furosemide is associated with increased risk of gouty arthritis secondary to furosemide-induced hyperurecemia and cyclosporine impairment of renal urate excretion
Caution is advised when using Lasix (furosemide) in patients with gout, as it may precipitate gouty arthritis or worsen hyperuricemia. It is recommended to monitor uric acid levels and use alternative treatments if possible, especially in patients with a history of gout or hyperuricemia 2.
From the Research
Lasix (Furosemide) and Gout
- Lasix (furosemide) is a loop diuretic that can increase uric acid levels, potentially worsening gout symptoms 3.
- The use of diuretics, including furosemide, is a known risk factor for developing hyperuricemia and gout, particularly in the elderly 3.
- In patients with gout, it is essential to consider the potential effects of diuretics on uric acid levels and gout symptoms when selecting medications 4, 5.
Alternative Treatment Options
- For patients with gout and cardiovascular disease or heart failure, alternative diuretics or treatment strategies may be necessary to minimize the risk of adverse cardiovascular events 6.
- Urate-lowering therapy (ULT) with medications such as allopurinol or probenecid may be considered to reduce uric acid levels and prevent gout flares 5, 7, 6.
- Non-pharmacological treatments, such as topical ice and rest, may also be useful in managing acute gout symptoms 5.
Important Considerations
- Patients with gout should be monitored closely for changes in uric acid levels and gout symptoms when taking diuretics like furosemide 4, 5.
- The selection of medications for gout management should be individualized based on patient-specific factors, including comorbidities and cardiovascular risk factors 7, 6.