What medication is used to treat gout?

From the Guidelines

The most effective medication for treating gout is allopurinol, which is recommended as the first-line urate-lowering therapy (ULT) for patients with gout, starting at a low dose of 100 mg daily and gradually increasing to achieve a target uric acid level below 6 mg/dL. According to the 2020 American College of Rheumatology guideline for the management of gout 1, allopurinol is the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage ≥3).

For acute gout flares, medications such as colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are commonly used. Colchicine is typically given as 1.2 mg initially, followed by 0.6 mg one hour later, then 0.6 mg once or twice daily until the attack resolves 1. NSAIDs like indomethacin (50 mg three times daily) or naproxen (500 mg twice daily) are also effective for 3-5 days.

It's essential to note that the choice of medication should be based on the presence of contraindications, the patient's previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved 1. Patients should also maintain adequate hydration, limit alcohol consumption, and reduce intake of purine-rich foods like red meat and seafood to help manage gout effectively.

Key points to consider when treating gout include:

• Starting allopurinol at a low dose and gradually increasing to achieve a target uric acid level below 6 mg/dL
• Using colchicine, NSAIDs, or corticosteroids for acute gout flares
• Maintaining adequate hydration and limiting alcohol consumption
• Reducing intake of purine-rich foods like red meat and seafood
• Considering patient preferences and values when making treatment decisions 1.

From the FDA Drug Label

Allopurinol tablets are indicated in:

1. the management of patients with signs and symptoms of primary or secondary gout (acute attacks, tophi, joint destruction, uric acid lithiasis, and/or nephropathy).

The recommended dosage of Colchicine Tablets, USP for prophylaxis of gout flares for adults and adolescents older than 16 years of age is 0.6 mg once or twice daily.

The medications used to treat gout are:

• Colchicine: for prophylaxis of gout flares at a dose of 0.6 mg once or twice daily, and for treatment of gout flares at a dose of 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later.
• Allopurinol: for the management of patients with signs and symptoms of primary or secondary gout (acute attacks, tophi, joint destruction, uric acid lithiasis, and/or nephropathy) 23

From the Research

Medications for Gout Treatment

The following medications are used to treat gout:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 4, 5, 6, 7, 8
• Colchicine 4, 5, 6, 7, 8
• Corticosteroids 4, 5, 6, 7, 8
• IL-1 inhibitors, such as canakinumab 5, 7, 8
• Urate-lowering therapies, including allopurinol and febuxostat 5, 6, 8
• Uricosuric agents, such as probenecid, sulfinpyrazone, and benzbromarone 5, 6
• Novel therapies, including verinurad, arhalofenate, and pegloticase 8

Considerations for Medication Selection

When selecting a medication for gout treatment, the following factors should be considered:

• Efficacy and potential adverse effects of the medication 4, 5, 6, 7, 8
• Patient comorbidities, such as renal insufficiency, gastrointestinal bleeding, and haemorrhage diathesis 4, 6, 7
• Pharmacokinetic properties of the medication, such as rapid absorption and short half-life 4
• Patient preference and lifestyle modifications, such as dietary changes and avoidance of alcohol 6, 8