From the Guidelines
For an acute gout flare, the primary treatment options are NSAIDs, colchicine, or corticosteroids, with the choice of drug based on the presence of contraindications, patient's previous experience, and time of initiation after flare onset. The most recent and highest quality study, 1, recommends that fully informed patients should be educated to self-medicate at the first warning symptoms of a gout flare. The recommended first-line options for acute flares are:
- Colchicine (within 12 hours of flare onset) at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1
- An NSAID (plus proton pump inhibitors if appropriate)
- Oral corticosteroid (30–35 mg/day of equivalent prednisolone for 3–5 days)
- Articular aspiration and injection of corticosteroids It is essential to note that colchicine and NSAIDs should be avoided in patients with severe renal impairment, and colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors. Additionally, patients with kidney disease, heart failure, or on blood thinners should consult their doctor before taking NSAIDs, as medication choice may need adjustment based on individual health conditions, as suggested by 1 and 1. In cases where patients have frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids, IL-1 blockers should be considered for treating flares, as recommended by 1. Overall, the treatment of acute gout flares should prioritize reducing inflammation and alleviating symptoms, while also considering individual patient factors and potential contraindications.
From the FDA Drug Label
The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0. 6 mg (one tablet) one hour later. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis
The medications for an acute gout (gouty arthritis) flare-up are:
- Colchicine (PO): 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later 2
- Indomethacin (PO): effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis 3
From the Research
Medications for Acute Gout Flare-up
The following medications are used to treat acute gout flare-ups:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 4, 5, 6, 7, 8
- Colchicine 4, 5, 6, 7, 8
- Corticosteroids 4, 5, 6, 7, 8
- Adrenocorticotropic hormone (ACTH) 6, 7
- Interleukin-1 (IL-1) inhibitors, such as canakinumab 5, 6, 8 and rilonacept 6, 8
- Intra-articular corticosteroids 7
Considerations for Medication Selection
When selecting a medication for an acute gout flare-up, the following factors should be considered:
- Comorbidities, such as renal insufficiency, gastrointestinal bleeding, and haemorrhage diathesis 4, 5, 7
- Potential adverse effects, such as gastrointestinal toxicity and renal insufficiency 4, 6, 7
- Pharmacokinetic properties, such as rapid absorption and short half-life 4
- Patient preference and tolerance 5, 7
Dosage and Administration
The dosage and administration of medications for acute gout flare-ups may vary depending on the specific medication and patient factors. For example: