Gout Medication List

A pharmacist explains how gout medications work.

Medically reviewed by Lindsay Cook, PharmD

Gout is an inflammatory arthritis caused by the build-up of uric acid crystals in the joints.

Uric acid is made in the body from purines found in some foods.

This uric acid (hyperuricemia) build-up causes pain and swelling, typically in one joint at a time. The big toe is often the first body part that's affected.

Males and people with a family history of gout are at an increased risk of developing it. Other risk factors include the following:

• Older age

• Drinking alcohol

• Drinking sugary beverages

• Eating foods rich in purines, like meats and seafood

• Being overweight

• Kidney disease

• High blood pressure

• Taking medications like water pills (diuretics), aspirin, and niacin

Here's what you need to know about medications that control gout and prevent acute attacks.

Overview of Gout Medications

Medications for gout are aimed at preventing and treating flares.

Flares, or gout attacks, are times of acute, intense pain and swelling in the joints. They often strike at night and can last days to weeks if not treated.

Gout medicines also prevent kidney stones and tophi (uric acid build-up below the skin, which can damage joints).

The main categories of gout medications are:

• Urate-lowering drugs, which lower the amount of uric acid in the body. These medicines are used to prevent gout flares.

• Anti-inflammatory medicines that decrease swelling and pain during flares.

Keep in mind that early diagnosis and treatment are crucial to prevent gout attacks and long-term joint damage. Your healthcare provider can diagnose gout based on uric acid levels in your blood or by using an X-ray or ultrasound.

Urate-Lowering Drugs

Urate-lowering drugs are used to help manage chronic gout and prevent flares.

They are recommended for people who have at least two gout flares per year and those with complications like tophi.

These medications can be initiated during a flare and will likely need to be taken indefinitely (life-long).

This class of drugs includes the following medicines:

• Allopurinol, which blocks the production of uric acid. This is the preferred medication for chronic gout.

• Uloric (febuxostat), which also blocks the production of uric acid- but isn't recommended for people with heart disease.

• Probenecid, which helps the kidneys remove uric acid from the body. This medicine is less effective than allopurinol or Uloric, and it's not recommended for people with a history of kidney stones.

• Krystexxa (pegloticase) is an intravenous (IV) medicine that breaks down uric acid. This is typically only used if other medicines haven't worked well.

Taking either allopurinol or Uloric for six months has been shown to restore normal uric acid levels in the body. But keep in mind that 87% of people who stop taking urate-lowering drugs will have a flare within five years.

Anti-Inflammatory Medications

Anti-inflammatory medications are used short-term to reduce pain and inflammation caused by a gout flare.

These medicines include the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like Motrin (ibuprofen), Aleve (naproxen), or Celebrex (celecoxib). High doses of these medicines are typically needed for three to five days to resolve the flare and prevent another. Your healthcare provider or pharmacist can help you pick the most appropriate NSAID. Of note, all the drugs in this class may raise blood pressure and can increase the risk of heart failure.

• Corticosteroids, such as prednisone, which can be injected into the joint or taken by mouth. As with NSAIDs, short courses are used to minimize side effects. Adverse effects of steroids include trouble sleeping, anxiety, and weight gain.

• Colcrys (colchicine) is most effective when started at the first symptoms of a gout flare. Colchicine may need to be dosed lower for people with chronic kidney disease (CKD) and those who take some medications, such as statins. Be sure to run your medication list by your healthcare provider or pharmacist to be safe. In contrast to NSAIDs and corticosteroids, colchicine may be continued long-term to prevent recurrent flares.

Other options include adrenocorticotropic hormone (ACTH)and interleukin-1 inhibitors such as the following:

• Ilaris (canakinumab)

• Kineret (anakinra)

• Arkalyst (rilonacept) and ACTH

These medications are expensive, and there's not enough research to know how effective they are for gout. They're not typically used unless standard treatments haven't worked.

Pain Relief at Home

Some simple strategies for managing mild to moderate gout pain can help protect the joint from further damage.

These home remedies include the following:

• Rest

• Applying ice

• Elevating the affected joint

These strategies can be used in conjunction with prescription medications or over-the-counter (OTC) NSAIDs for gout.

Supplements for Gout

Supplements that have been studied for gout include the following:

• Fish oil. Omega-3 fatty acids can help prevent gout attacks while urate-lowering medications are being started.

• Folic acid can help lower uric acid levels in adults with high blood pressure.

• Vitamin C has not been proven effective for gout.

• Vitamin D. Low vitamin D levels are associated with high levels of uric acid, but more research is needed to determine if supplementing is beneficial.

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian nutritionist (RD or RDN), pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.

Related: How Do I Choose a Supplement?

Potential Side Effects and Risks

All medications have the potential to cause side effects. These side effects can be minor or severe.

Some gout medications are associated with gastrointestinal issues, allergic reactions, and interactions with other drugs.

Keep the following precautions in mind when using medications for gout.

• Allopurinol can cause hypersensitivity reactions. These severe allergic reactions are more common in Blacks and people of Southeast Asian descent.

• Uloric may increase the risk of heart disease, though the research is conflicting.

• NSAIDs can raise blood pressure and shouldn't be taken in people with kidney disease. They also shouldn't be taken with diuretics or blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors, such as Zestril (lisinopril).

• Colchicine interacts with other medicines broken down by the liver enzyme cytochrome P450 3A4. A few examples include statins, antifungals, and some heart medicines.

Discussing your therapy with healthcare providers for personalized treatment recommendations and monitoring is key.

Gout Prevention

Dietary and lifestyle modifications can help prevent flares.

Here are some practical steps to implement as you are able.

Gout Triggers

Gout flares can be triggered by different conditions that stress the body. Some common triggers include the following:

• Medications such as low-dose aspirin, diuretics, and testosterone

• Being overweight

• Injuries

• Dehydration

• Alcohol consumption

• High-purine diet

• Surgery

• Trauma

• Stress

• Extreme weather conditions

While it's impossible to eliminate some of these triggers, it's essential to try to minimize the ones you can control. Eating a healthy diet, staying hydrated, and managing stress can help lower the risk of gout flares.

Gout Diet

Gout is exacerbated by purine-rich foods such as the following:

• Red meat, like beef

• Organ meat, like liver and kidney

• Seafood, like shrimp, lobster, and sardines

Limiting these foods may help ward off a gout attack.

Research shows that low-fat, low-carbohydrate diets can help minimize gout flares when used in a comprehensive gout management plan. These include the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet.

Cutting down on sugary drinks and alcohol can also help prevent flares. However, remember that dietary changes with medications are helpful.

Resources and Support

If you've been diagnosed with gout, it's important to know where to find information, encouragement, and practical tips for managing your condition.

Check out gout resources from these reputable sources:

• Centers for Disease Control and Prevention (CDC)

• American College of Rheumatology

• National Institute of Arthritis and Musculoskeletal and Skin Diseases

• Gout Central mobile app from the National Kidney Foundation

Some online support groups to help empower you include:

• Gout Connect Group from the Arthritis Foundation

• Alliance for Gout Awareness
  

When to Talk to Your Healthcare Provider

Be sure to talk to your healthcare provider promptly if:

• You have symptoms of a gout flare for the first time. Symptoms include intense redness, pain, and swelling at a joint.

• Your prescribed medications for a gout flare aren't working.

Summary

There are two main types of medications for gout.

Urate-lowering medications (allopurinol, Uloric, and probenecid) are used to prevent gout flares in people who have at least two flares a year. They are also recommended for people who have complications from gout, including tophi.

Anti-inflammatory medications include NSAIDs, corticosteroids, and colchicine. These medications are used to reduce pain and swelling in acute gout attacks. NSAIDs and steroids are used short-term to minimize side effects, while colchicine can be used indefinitely.

Home remedies like rest, ice, and elevation can help manage gout flares. Supplements may help, though more research is needed to know for sure.

Prevention of gout is based on eating a healthy diet and minimizing gout triggers. These triggers can include stress, joint injuries, and weather extremes.

Reach out to your healthcare provider if your symptoms worsen or your medications are not working.

Read the original article on Verywell Health.