Gout medicine that your doctor may prescribe to treat this condition includes medications like anti-inflammatory, analgesics and corticosteroids. These are typically used in acute cases, and can also be taken in low doses to prevent future flare-ups.
There are also other medicines available that help prevent complications caused by the disease. These prevent the production of uric acid or promote its elimination.
Gout treatment should be individualized and based on the severity of symptoms, duration of the attack, affected areas of the body, contraindications and previous experience with treatment.
The most commonly-prescribed gout medicines are:
1. Nonsteroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs, also known as NSAIDs (like ibuprofen, naproxen, indomethacin or celecoxib) are commonly used to alleviate symptoms of acute gout. For this purpose, they are prescribed in higher doses, while lower doses can be prescribed to prevent flare-ups in the future.
Side effects: These medications can cause gastric side effects, such as stomach pain, bleeding and ulcers, especially in people who take these medications daily. To reduce these effects, these medications are ideally taken after meals. The doctor may also prescribe a stomach protector to be taken every day, on an empty stomach, to alleviate discomfort from NSAID use.
Long-term use can also cause kidney problems, increased blood pressure, heart problems, fluid retention, and allergic reactions.
Contraindications: These medications should be avoided by people who are hypersensitive to NSAIDs or salicylates, as well as by people who have had an allergic event through ingesting this type of medication. It should also not be used by pregnant or lactating women, without medical advice or by people who have undergone surgery involving coronary lesions.
2. Colchicine
Colchicine is a medicine commonly prescribed to treat and prevent gout attacks. It prevents urate crystals from depositing in the joint, which can reduce the inflammatory response and any pain that follows. This medication can taken used daily to prevent flare-ups, while higher doses are prescribed during active gout attacks.
Side effects: Colchicine can cause some adverse effects such as diarrhea, nausea and vomiting. In high doses, it can lead to the appearance of skin rashes, gastrointestinal bleeding and abnormalities in the liver and kidneys.
Contraindications: This medication should be avoided by people who are allergic to this medication or any of the components in its formula. It should not be taken if you have severe kidney, gastrointestinal or liver diseases, have stomach ulcers, or have a history of heart or blood diseases. Colchicine should also be avoided during pregnancy and breastfeeding.
3. Corticosteroids
The doctor may prescribe corticosteroids such as prednisone tablets or injectable methylprednisolone to reduce pain and inflammation. These are mostly indicated in situations where people cannot take other anti-inflammatories such as indomethacin or celecoxib, or when colchicine is contraindicated.
Side effects: Corticosteroids can cause some adverse effects, such as mood swings, increased blood sugar levels and increased blood pressure.
Contraindications: This medication should not be used by people with hypersensitivity to steroids and other components present in the formula. It should also not be used by people with systemic fungal infections or uncontrolled infections.
Furthermore, corticosteroids should be used with caution by people with hypertension, heart failure, osteoporosis, epilepsy, gastroduodenal ulcers, diabetes, glaucoma, obesity or psychosis. People with these conditions are especially it is important that their use is carried out in accordance with the doctor's instructions.
4. Allopurinol
Allopurinol is a medications that blocks the production of uric acid by inhibiting xanthine oxidase, an enzyme that converts xanthine into uric acid, bringing its levels in the blood, reducing the risk of gout attacks.
Side effects: Allopurinol can cause some adverse reactions such as high levels of thyroid-stimulating hormones and rashes, in which cases use should be discontinued and reassessed by a doctor. Although uncommon, allopurinol can also cause vomiting, nausea, diarrhea, general malaise, headache, fever, chills, blood in the urine and fatigue.
Contraindications: This medicine should not be used by pregnant or breastfeeding women, nor should it be used by people who are allergic to it.
5. Probenecid
Probenecid is a medication that can be used to eliminate excess uric acid in the urine. It works by increasing its concentration in the bloodstream.
Side effects: Some of the most common side effects that can occur with probenecid are stomach upset and kidney stones.
Contraindications: This medicine should not be used by children under 2 years of age or by people with active liver or kidney disease, blood dyscrasia, uric lithiasis, active peptic ulcers or if they have had an allergic reaction to this medicine. Furthermore, it is not recommended during pregnancy and breastfeeding without medical advice.
Other medications, such as losartan, calcium channel antagonists, fenofibrate and statins, are also beneficial for reducing uric acid and may be considered by your doctor for the treatment of gout.