Gout - Medications

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Gout - Medications
By Jan Nissl, RN, BS

Medications
Medication treatment for gout may be done in two separate stages.

First, the pain, swelling, redness, and warmth (inflammation) during an attack of gout is treated until the symptoms have gone away.
Second, after the inflammation has subsided (2 to 4 weeks), other medications may be used to reduce the uric acid level in the blood and reduce the frequency of future attacks.
Medications to lower uric acid levels are not given until a gout attack is over. Starting these medications during a gout attack can cause movement of uric acid stored elsewhere in the body, which can make the gout attack worse.

Long-term medication treatment depends on how high your uric acid levels are and how likely other gout attacks are. In general, the higher the uric acid levels and the more frequent the attacks, the more likely it is that long-term medication treatment will help.

During a gout attack

You may already be taking a medication to lower uric acid levels in the blood at the time of an attack. If so, you should continue taking your medication, even during an attack.

If you have been prescribed a medication to lower uric acid levels (probenecid or allopurinol) and have not been taking the medication, it is more likely that another gout attack will occur. Do not start taking the medication during an attack. Medications that control the uric acid levels in your blood can also make the uric acids stored elsewhere in the body move into your bloodstream. Starting these medications while you are having a gout attack can make your attack much worse.

Medication Choices
Medication treatment for gout usually involves some combination of:

Short-term treatment, using medications that relieve pain and reduce inflammation during an acute attack or prevent a recurrence of an acute attack. These medications may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), except for aspirin, which should never be used to relieve pain during a gout attack. Aspirin may abruptly change uric acid levels in the blood and may make the attack worse.7
Colchicine, which may also be used for long-term treatment.
Corticosteroids, which may be given in pills or by a shot for cases of gout that do not respond to NSAIDs or colchicines. They may also be given to people who cannot take NSAIDs for other reasons, such as those with chronic kidney failure, heart failure, gastrointestinal bleeding or those using a blood-thinner, such as warfarin.
Long-term treatment, using medications to lower uric acid levels in the blood, which can reduce the frequency and severity of gout attacks in the future. This may include:
Uricosuric agents to increase elimination of uric acid by the kidneys.
Allopurinol to decrease production of uric acid by the body.
Colchicine to prevent flare-ups during the first months that you are taking uric acid-lowering medications.
What To Think About
Relief from symptoms in a gout attack often occurs within 24 hours if treatment is started immediately.
During a gout attack, your health professional will prescribe a maximum daily dose of one or more medications used for short-term treatment to stop the attack quickly. Doses are then reduced as the symptoms go away.
NSAIDs other than aspirin are used most often to treat a gout attack.
Because all medications that lower uric acid levels in the blood have associated risks, an accurate diagnosis of gout is necessary before they are used.
Aspirin should never be used to relieve pain during a gout attack because it slows the elimination of uric acid and can raise uric acid levels further.
Gout attacks in older people can take longer to go away.
Some people with gout have continuing problems because they do not take their prescribed medication. Although most people will need treatment for the rest of their lives to keep their uric acid levels in their blood normal, they may feel perfectly healthy the majority of the time and wonder why they should continue taking their medication. If you stop taking your prescribed medication, nothing may happen at first, but after a while another gout attack is likely to occur. Without treatment, future attacks are likely to be more severe and occur more often.

Research to develop new medications to treat the symptoms of gout is ongoing. Scientists also are studying which medications lower uric acid levels safely.

Losartan is used to treat high blood pressure (hypertension); it also lowers uric acid levels.8
Fenofibrate is used to control certain fats in the blood (triglycerides and very low-density lipoprotein cholesterol); it may also increase elimination of uric acid by the kidneys.
Pegylated urate oxidase may lower uric acid levels by changing uric acids into an absorbable molecule. This medication is currently being evaluated in the United States.
Febuxostat and Y-700 medicines decrease the amount of uric acid the body makes. These medicines are being studied and may be used in people who cannot take allopurinol.9

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