NSAIDs, Colchicine, and Other Medications for Gout
The American College of Rheumatology recently developed non-pharmaceutical and pharmaceutical treatment recommendations for both aute and chronic gout.
Medications are a typical part of a treatment plan for gout. Some of the medications available help reduce symptoms of a gout attack, while others help prevent attacks. Certain medications can also help reduce your risk of gout-related complications such as kidney stones. When it comes to taking medications for gout, everyone is different. You may need 1 medication to treat gout or you may need a combination of medications.
Have a conversation with your doctor before trying a new medication; some medications can interact with other medications you already take.
Medications for a Gout Attack
A gout attack can happen without warning, but medications taken at the first sign of pain and inflammation can help reduce your symptoms and the length of the attack.
Symptoms are typically the most severe within the first 24 hours, but fortunately, pain usually goes away within the first 12 hours of starting one of these medications. Your symptoms can be fully relieved within 48 hours, which means you can get back to your daily activities.
Below are 3 common medications used to treat a acute gout attack (flare).
Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are the most common treatment for an acute attack. They help reduce pain and inflammation caused by uric acid crystals. However, they have no effect on how much uric acid there is in your body.
You can take over-the-counter (OTC) NSAIDs, such as naproxen (eg, Aleve), and prescription-strength NSAIDs, such as indomethacin (eg, Indocin) and sulindac (Clinoril), to stop an acute attack. Your doctor will have you try an OTC NSAID before prescribing you a stronger NSAID.
As with other medications, NSAIDs can have side effects. The most common are gastrointestinal issues such as ulcers and stomach bleeding.
Colchicine: This medication is traditionally taken in pill form, and it is most effective when taken within the first 12 hours of a gout attack. You may need to take it once or twice a day to reduce pain and inflammation.
Colcrys—the brand name of colchicine—is approved by the US Food and Drug Administration (FDA) to treat gout.
Colchicine is not an option for everyone because it’s very expensive. Also, it can cause intense side effects such as severe diarrhea, nausea, vomiting, and abdominal cramping.
Corticosteroids: If you’ve tried NSAIDs and colchicine and they haven’t worked for you, you may want to try a corticosteroid. You can take a corticosteroid in pill form or get an injection into the affected joint to help relieve pain and inflammation.
Prednisone is a common corticosteroid prescribed for a gout attack. Within a few hours of taking this medication, you may notice relief.
An injection can also reduce symptoms of a gout attack. For example, if only 1 joint is affected—let’s say your toe—a steroid injection may be more beneficial for you than taking an oral steroid.
Corticosteroids can thin your bones and make it harder for you to fight infections, so talk to your doctor about whether they’re an option for you.
Another option is ACTH (adrenocortocotropic hormone; Corticotropin), which is given as a subcutaneous injection. ACTH has similar side effects as oral steroids, but with less effect on the body's immune system (ability to fight infection).
Medications to Prevent Gout Attacks
Many people who have a gout attack won’t experience another one. But for some people, gout attacks can progress and become chronic gout. Fortunately, there are medications to help prevent gout attacks when you have chronic gout.
The same medications that are used to treat a gout attack can also be used to help prevent attacks.
NSAIDs: A low-dose NSAID—either an OTC or a prescription-strength NSAID—taken daily can help prevent gout attacks. Your doctor will help you determine which NSAID to take.
Colchicine: Your doctor may prescribe a low dose of colchicine daily to prevent attacks.
Corticosteroids: Oral corticosteroids can be prescribed when you have frequent attacks. But as mentioned above, they can cause side effects such as thinning of your bones. If your doctor prescribes a corticosteroid to prevent attacks, he or she will find the lowest dose possible for you and will monitor you while you’re on them.
Medications to Help Lower Uric Acid Levels
Your doctor may prescribe a medication to help lower your uric acid levels, reducing your risk of hyperuricemia.
Xanthine oxidase inhibitors: These medications are taken long-term because they help lower the levels of uric acid in your body, reducing your risk of a gout attack.
Allupurinol (eg, Zyloprim, Lopurin) and fubuxistat (eg, Uloric) are examples of xanthine oxidase inhibitors.
If, however, you’re already on a xanthine oxidase inhibitor and you have an attack, you should continue taking it.
Probenecid: Probenecid is sometimes used to treat gout because it lowers your uric acid levels by promoting the elimination of uric acid in your urine. As with xanthine oxidase inhibitors, it’s used to prevent gout attacks—not treat their symptoms.
Benemid and Probalan are examples of probenecid. This medication is typically prescribed for younger, healthier people, and are taken twice daily.
Other Medications for Gout
Sometimes other medications are prescribed to help treat gout, especially if you have severe tophaceous gout. Often, this form of gout doesn’t respond to any of the medications listed above.
Biologics: It’s thought that certain biologic medications help treat gout by blocking chemicals, such as tumor necrosis factor-alpha, that may play a role in the inflammation of gout.
In 2010, the FDA approved the first biologic medication for gout called pegloticase (Krystexxa). This medication is given intravenously every 2 weeks. It helps to eliminate uric acid from the body.
It’s typically prescribed for people who have severe gout who have not found relief with other medications.
Another biologic your doctor may prescribe for gout is anakinra (Kineret). While it’s not FDA-approved, anakinra is a daily 100 mg injection you can give yourself to reduce inflammation. Rest assured, your doctor will teach you how to do the injection. After the injection, you may notice relief within hours.
Infections are a possible side effect of anakinra, but this medication can be used if nothing else works.
Medications that treat other health conditions: Some people who have other health conditions—such as high blood pressure and high triglycerides—may notice that the medications they take for those conditions can also help reduce uric acid levels.
Examples of these medications are losartan (a blood pressure medication) and fenofibrate (a medication that helps reduce triglycerides).
Opioids: In some cases, gout-related pain may be so severe that your doctor may prescribe you an opioid, such as hydrocodone or ocycodone with acetaminophen, hydromorphone, or morphine. Opioids are very powerful medications, so your doctor will carefully monitor you while you’re on this medication.
Gout Medications Conclusion
While there are several medication options for gout, researchers continue to investigate which medications are most effective.
These medications treat your symptoms, and they can help prevent gout attacks. Your doctor will work with you to develop a gout treatment plan—one that may include a combination of treatments such as medications and diet modifications.