Complete Guide to Gout Medications: What They Do and How to Use Them

Understanding your gout medications is crucial for effective management. This comprehensive guide covers the main types of gout drugs, how they work, potential side effects, and what to expect from treatment.

Two Types of Gout Medications

Gout medications fall into two main categories:

Acute treatment - For managing active attacks
Long-term prevention - For lowering uric acid and preventing future attacks

Both types are often necessary for comprehensive gout management.

Medications for Acute Gout Attacks

These medications treat pain and inflammation during active flares:

1. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

Common Options:

Indomethacin (Indocin) - Most commonly prescribed
Naproxen (Aleve, Naprosyn)
Ibuprofen (Advil, Motrin)
Celecoxib (Celebrex)

How They Work:

Reduce inflammation
Relieve pain
Most effective when started early

Typical Dosing:

Indomethacin: 50 mg three times daily initially
Naproxen: 750 mg initially, then 250 mg every 8 hours
Higher doses than used for general pain relief

Pros:

Fast-acting (within hours)
Very effective for most people
Relatively inexpensive
Available over-the-counter (lower doses)

Cons:

Stomach irritation and ulcers
Can worsen kidney function
May increase blood pressure
Cardiovascular risks with long-term use
Can interact with blood thinners

Who Should Avoid:

People with kidney disease
History of stomach ulcers
Heart disease or stroke risk
Taking blood thinners

Best For: First-line treatment for acute attacks in people without contraindications.

2. Colchicine

Brand Names: Colcrys, Mitigare

How It Works:

Prevents white blood cells from causing inflammation
Most effective when taken within 12-24 hours of symptom onset

Typical Dosing:

Acute attack: 1.2 mg at first sign, then 0.6 mg one hour later
Low-dose prophylaxis: 0.6 mg once or twice daily

Pros:

Very effective if taken early
Can be used for prevention
Safer for kidneys than NSAIDs
Works differently than other options

Cons:

Diarrhea (very common side effect)
Nausea and vomiting
Abdominal cramping
Must be taken early in attack
Multiple drug interactions
More expensive than NSAIDs

Important Drug Interactions:

Statins (can cause muscle damage)
Clarithromycin and erythromycin
Diltiazem and verapamil
Grapefruit juice

Best For: People who can't take NSAIDs, or as prophylaxis when starting uric acid-lowering therapy.

3. Corticosteroids

Common Options:

Prednisone (oral)
Prednisolone (oral)
Cortisone injection (directly into joint)
Methylprednisolone (Medrol Dose Pack)

How They Work:

Powerful anti-inflammatory effects
Suppress immune response causing inflammation

Typical Dosing:

Prednisone: 30-40 mg daily for 3-5 days, then taper
Injection: Single dose directly into affected joint

Pros:

Very effective
Work for people who can't take NSAIDs or colchicine
Joint injection provides rapid relief
Can use when kidney function is impaired

Cons:

Blood sugar spikes (concern for diabetics)
Increased blood pressure
Mood changes
Sleep disturbances
Weight gain with long-term use
Weakened immune system
Bone loss with repeated use

Best For: People who can't tolerate NSAIDs or colchicine, diabetics (with careful monitoring), those with kidney issues.

Medications for Long-Term Gout Management

These medications lower uric acid levels to prevent future attacks:

1. Allopurinol

Brand Name: Zyloprim

How It Works:

Inhibits xanthine oxidase enzyme
Reduces uric acid production
Most commonly prescribed preventive medication

Typical Dosing:

Start: 100 mg daily
Gradually increase to 200-300 mg daily (sometimes higher)
Take consistently, even during attacks
Dose adjusted based on uric acid levels and kidney function

Target: Keep uric acid below 6.0 mg/dL

Pros:

Very effective
Once-daily dosing
Inexpensive (generic available)
Decades of safety data
Works for most people

Cons:

Rare but serious skin reactions (stop immediately if rash develops)
Must start slow to avoid triggering attacks
Takes weeks to months for full effect
May initially increase attack frequency
Requires monitoring

Side Effects:

Skin rash (stop medication and call doctor immediately)
Stomach upset
Drowsiness
Headache

Serious Warning:

Allopurinol hypersensitivity syndrome (rare but potentially fatal)
Risk higher in those with kidney disease or certain genetic factors
Stop immediately if rash develops

Best For: First-line long-term treatment for most gout patients.

2. Febuxostat (Uloric)

How It Works:

Also inhibits xanthine oxidase
Similar to allopurinol but newer

Typical Dosing:

Start: 40 mg daily
Can increase to 80 mg daily if needed

Pros:

May be more effective than allopurinol in some cases
Once-daily dosing
Can use in mild-moderate kidney disease
Alternative for those who can't tolerate allopurinol

Cons:

More expensive
May increase cardiovascular events (FDA warning)
Similar attack risk when starting
Requires prophylaxis when beginning

FDA Warning:

Increased risk of heart-related death compared to allopurinol
Generally recommended only if allopurinol doesn't work or causes problems

Best For: People who can't tolerate or don't respond to allopurinol, without significant heart disease.

3. Probenecid

How It Works:

Increases uric acid excretion through kidneys
Different mechanism than allopurinol/febuxostat

Typical Dosing:

Start: 250 mg twice daily
Gradually increase to 500-1,000 mg twice daily

Pros:

Alternative mechanism of action
Can combine with allopurinol for better effect
No risk of hypersensitivity syndrome

Cons:

Less effective than xanthine oxidase inhibitors
Requires good kidney function
Increases kidney stone risk
Multiple doses daily
Many drug interactions

Who Can't Use:

Kidney disease or kidney stones
Taking aspirin
History of uric acid kidney stones

Best For: People with good kidney function who under-excrete uric acid and can't take xanthine oxidase inhibitors.

4. Pegloticase (Krystexxa)

How It Works:

IV infusion that breaks down uric acid
Most powerful uric acid-lowering treatment

Typical Dosing:

IV infusion every 2 weeks
Given in medical facility

Pros:

Extremely effective
For severe, refractory gout
Can dissolve tophi

Cons:

Very expensive
Requires IV infusion
High risk of infusion reactions
Only for severe cases that haven't responded to other treatments
May develop antibodies that reduce effectiveness

Best For: Severe, debilitating gout that hasn't responded to other treatments.

Starting Uric Acid-Lowering Medication

What to Expect

First Few Months:

Paradoxically, attack frequency may increase initially
This happens as uric acid crystals dissolve and shift
Usually temporary (2-6 months)

Important:

Don't stop medication if attacks occur
This is actually a sign the medication is working

Prophylaxis (Attack Prevention During Initiation)

To prevent attacks when starting uric acid-lowering drugs:

Options:

Low-dose colchicine (0.6 mg once or twice daily)
Low-dose NSAIDs (if tolerated)
Low-dose prednisone

Duration: Typically 3-6 months

Monitoring

Regular blood tests to check:

Uric acid levels (every 2-4 weeks initially)
Kidney function
Liver function
Blood counts

Common Questions About Gout Medications

"Can I stop medication once my levels are normal?"

No. Uric acid will typically rise again without medication. Gout is usually a chronic condition requiring ongoing treatment.

"Do I take medication during an attack?"

Yes. Continue your uric acid-lowering medication during attacks. Don't stop or start these medications during a flare.

"How long until medications work?"

Acute medications: Hours to days
Preventive medications: Weeks to months for full effect

"Can I drink alcohol on gout medication?"

Limit alcohol regardless of medication. Check with your doctor about specific interactions.

"What if I miss a dose?"

Take it as soon as you remember unless it's almost time for the next dose. Don't double up.

Side Effect Management

Common Side Effects and Solutions

Stomach upset (NSAIDs, colchicine):

Take with food
Try different NSAID
Use stomach-protecting medication

Diarrhea (colchicine):

Lower dose if possible
May improve over time
Take with food

Skin rash (allopurinol):

Stop medication immediately
Contact doctor right away
May need alternative

Working with Your Doctor

Questions to Ask

"Which medication is best for me?"
"What's my target uric acid level?"
"How long will I need to take this?"
"What side effects should I watch for?"
"What do I do if I have an attack while on medication?"
"Do my other medications interact?"

What to Report

New or worsening symptoms
Side effects
Difficulty affording medications
Problems with adherence

Medication Adherence Tips

Taking medications consistently is crucial:

Set phone reminders
Use pill organizer
Take at same time daily
Link to daily routine (breakfast, bedtime)
Track with apps
Understand why you're taking it

Download Gout Guru to track your medications, set reminders, and monitor how they're affecting your uric acid levels and symptoms.

Cost Considerations

Saving Money on Medications

Use generic versions when available
Check manufacturer assistance programs
Ask about 90-day supplies
Compare prices at different pharmacies
Use GoodRx or similar discount programs
Talk to doctor about cost concerns

The Bottom Line

Gout medications are highly effective when used correctly. Most people need both acute treatment for attacks and long-term prevention to control uric acid levels. Work closely with your doctor to find the right combination for you, be patient as medications take effect, and stay consistent with your treatment plan.

Remember: Gout is highly manageable with proper medication use. The key is finding what works for you and sticking with it long-term.

Track your medication effectiveness and side effects with Gout Guru to optimize your treatment plan.