Can a high dose of Lasix (furosemide) lead to a gout flare?

From the Guidelines

High doses of furosemide (Lasix) can indeed lead to gout flares, as it increases uric acid levels in the blood by reducing its excretion in the kidneys, which can precipitate gout attacks in susceptible individuals. Furosemide is a loop diuretic that competes with uric acid for the same transport mechanisms in the kidney tubules, resulting in hyperuricemia (elevated uric acid levels) [ 1 ]. According to the 2016 updated EULAR evidence-based recommendations for the management of gout, when gout occurs in a patient receiving loop or thiazide diuretics, substituting the diuretic if possible is recommended [ 1 ]. Patients taking high doses of furosemide, typically above 80mg daily, are at greater risk, especially those with a history of gout or elevated baseline uric acid levels. The risk increases with higher doses and longer duration of therapy.

Key Considerations

• Staying well-hydrated and limiting alcohol and purine-rich foods can help reduce the risk of gout while on furosemide therapy.
• If symptoms of gout occur, such as severe joint pain, swelling, redness, and tenderness, often in the big toe, patients should contact their healthcare provider.
• Healthcare providers may consider adjusting diuretic therapy, adding a uric acid-lowering medication like allopurinol, or prescribing colchicine for acute gout flares [ 1 ].

Management of Gout

• The 2016 updated EULAR evidence-based recommendations suggest that acute flares of gout should be treated as early as possible, and patients should be educated to self-medicate at the first warning symptoms [ 1 ].
• Recommended first-line options for acute flares include colchicine, NSAIDs, oral corticosteroids, or articular aspiration and injection of corticosteroids [ 1 ].

From the FDA Drug Label

Asymptomatic hyperuricemia can occur and gout may rarely be precipitated. Concomitant use of cyclosporine and Furosemide tablets is associated with increased risk of gouty arthritis secondary to Furosemide tablets-induced hyperurecemia and cyclosporine impairment of renal urate excretion

High doses of furosemide may lead to hyperuricemia, which can increase the risk of gout flare. However, the exact relationship between high-dose furosemide and gout flare is not explicitly stated in the label.

• Key points:
  • Asymptomatic hyperuricemia can occur
  • Gout may rarely be precipitated
  • Concomitant use of cyclosporine increases the risk of gouty arthritis 2 2

From the Research

High Dose of Lasix and Gout Flare

• The relationship between high doses of Lasix (a diuretic) and gout flare is supported by several studies 3, 4.
• Diuretics, including Lasix, can increase serum uric acid levels by increasing uric acid reabsorption and/or decreasing uric acid secretion, leading to hyperuricaemia and gout 3.
• A study found that thiazide diuretic therapy, which is similar to Lasix, was associated with a significantly increased risk for initiation of anti-gout therapy, particularly at doses of 25 mg/day or higher 4.
• While the exact mechanism of Lasix-induced gout flare is not fully understood, it is likely related to the increase in serum uric acid levels caused by the diuretic effect of Lasix 3, 4.
• Other studies have discussed the treatment and management of gout, including the use of urate-lowering therapies and anti-inflammatory medications 5, 6, 7, but do not specifically address the relationship between high doses of Lasix and gout flare.