From the Guidelines
During a gout flare, it is recommended to avoid certain medications that can worsen the condition, such as non-steroidal anti-inflammatory drugs (NSAIDs) in patients with kidney disease, heart failure, or a history of stomach ulcers, as well as aspirin, diuretics like hydrochlorothiazide and furosemide, and alcohol. The medications to avoid include:
- NSAIDs like ibuprofen (Advil, Motrin), naproxen (Aleve), and indomethacin (Indocin) in patients with kidney disease, heart failure, or a history of stomach ulcers 1
- Aspirin, even in low doses, as it can worsen a gout attack by inhibiting uric acid excretion 1
- Diuretics like hydrochlorothiazide and furosemide, which can raise uric acid levels 1
- Alcohol, which can increase uric acid production and worsen inflammation 1 Instead, medications like colchicine, prednisone, or other corticosteroids are typically recommended for acute gout treatment under medical supervision 1. It is also important to note that if you're taking allopurinol or febuxostat for long-term gout management, you should not start these medications during an acute flare as they can initially worsen symptoms; however, if you're already on these medications, you should continue taking them 1. The American College of Physicians recommends that clinicians choose corticosteroids, NSAIDs, or colchicine to treat patients with acute gout, and that urate-lowering therapy does not reduce the risk for acute gout attacks in the first 6 months in patients with gout 1.
From the FDA Drug Label
If patients are taking or have recently completed treatment with drugs listed in Table 1 within the prior 14 days, the dose adjustments are as shown in the table below [see Drug Interactions (7)]. Table 1 Colchicine Tablets, USP Dose Adjustment for Coadministration with Interacting Drugs if no Alternative Available
- For magnitude of effect on colchicine plasma concentrations [see Clinical Pharmacology (12. Strong CYP3A4 Inhibitors DrugNoted or Anticipated OutcomeGout FlaresFMF Prophylaxis of Gout FlaresTreatment of Gout Flares Original Intended DosageAdjusted DoseOriginal Intended DosageAdjusted Dose Atazanavir Clarithromycin Darunavir/Ritonavir Indinavir Itraconazole Ketoconazole Lopinavir/Ritonavir Nefazodone Nelfinavir Ritonavir Saquinavir Telithromycin Tipranavir/Ritonavir Significant increase in colchicine plasma levels *; fatal colchicine toxicity has been reported with clarithromycin, a strong CYP3A4 inhibitor 0.6 mg twice a day0.3 mg once a day 1.2 mg (2 tablets) followed by 0.6 mg (1 tablet) 1 hour later. Dose to be repeated no earlier than 3 days.0.6 mg (1 tablet) × 1 dose, followed by 0.3 mg (1/2 tablet) 1 hour later. Dose to be repeated no earlier than 3 days.
Patients should be advised that many drugs or other substances may interact with Colchicine Tablets, USP and some interactions could be fatal. Therefore, patients should report to their healthcare provider all of the current medications they are taking and check with their healthcare provider before starting any new medications, particularly antibiotics Patients should also be advised to report the use of nonprescription medication or herbal products. Grapefruit and grapefruit juice may also interact and should not be consumed during Colchicine Tablets, USP treatment
Medications to Avoid in Gout Flare:
- Strong CYP3A4 Inhibitors:
- Atazanavir
- Clarithromycin
- Darunavir/Ritonavir
- Indinavir
- Itraconazole
- Ketoconazole
- Lopinavir/Ritonavir
- Nefazodone
- Nelfinavir
- Ritonavir
- Saquinavir
- Telithromycin
- Tipranavir/Ritonavir
- Moderate CYP3A4 Inhibitors:
- Amprenavir
- Aprepitant
- Diltiazem
- Erythromycin
- Fluconazole
- Fosamprenavir
- Grapefruit juice
- Verapamil
- P-gp Inhibitors:
- Cyclosporine
- Ranolazine It is recommended to avoid these medications or adjust the dose of colchicine when co-administered with these medications to minimize the risk of adverse effects 2. Patients should consult their healthcare provider before taking any new medications, including antibiotics, and report any use of nonprescription medication or herbal products 2.
From the Research
Medications to Avoid in Gout Flare
When managing gout flare, it's essential to consider the medications that may exacerbate the condition. Although the provided studies do not directly answer the question of which medications to avoid, they do discuss the medications that are commonly used to treat gout flare and their potential side effects.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute gout, but they may have adverse effects such as gastrointestinal issues 3.
- COX-2 inhibitors (COXIBs) are also used to treat acute gout, but they may have similar efficacy to non-selective NSAIDs, with a potentially lower risk of gastrointestinal side effects 3.
- Glucocorticoids, such as oral, intraarticular, or intramuscular corticosteroids, can be used as first-line agents for gout flare management, but they may have side effects such as increased blood sugar levels and weight gain 4.
- Colchicine is another medication used to treat gout flare, but it can have side effects such as nausea, diarrhea, and abdominal pain 4, 5.
- Urate-lowering therapy, such as allopurinol and febuxostat, is used to prevent flare-ups, but febuxostat is associated with an increased risk of all-cause and cardiovascular mortality 6.
Potential Medications to Avoid
Based on the potential side effects and interactions, the following medications may be best avoided or used with caution in patients with gout flare:
- Diuretics, which can increase uric acid levels and worsen gout symptoms 6.
- Medications that can increase uric acid levels, such as cyclosporine and tacrolimus 6.
- Medications that can interact with gout treatments, such as warfarin and aspirin 6.
It is essential to consult with a healthcare professional to determine the best course of treatment for gout flare and to discuss potential medication interactions and side effects 3, 7, 4, 6, 5.