Gout Medication
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Book of Arthritis

 

Drug Prevention & Treatment

The prevention of gouty arthritis consists of taking medication to reduce the uric acid  and changing your diet to reduce the purine content.  The goals of gout attack treatments are to relieve the severe  pain, shorten the duration of inflammation during an acute attack, prevent future attacks and to prevent joint damage.

 

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Gout medications are used to:

  • Relieve the pain and swelling of an acute attack: nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, codeine, Demerol, corticosteroid drugs

  • Prevent future episodes: colchicine, probenecid, sulfinpyrazone, and allopurinol.

  • Prevent or treat tophi: probenecid, sulfinpyrazone, and allopurinol.

  • Prevent the formation of uric acid kidney stones: allopurinol

Colchicine has been used to treat gout for over 2,400 years. It relieves the pain and swelling of acute attacks. It works best if taken immediately after the onset of an attack. When taken by mouth, colchicine can cause diarrhea, nausea, and abdominal cramps. Colchicine is less popular now than in the past because of its slow onset of action and frequent gastrointestinal side effects. Colchicine interferes with neutrophil phagocytosis and chemotaxis -early events in the production of joint inflammation and is most effective when started soon after the onset of an attack of gouty arthritis. The beneficial effect of colchicine declines the longer treatment is delayed.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve the pain and swelling of an acute attack. They usually begin working within 24 hours. These medications are as effective as colchicine but may have less frequent side effects. Side effects from NSAIDs may include stomach upset, headache, skin rashes, and sometimes ulcers.

Medications that Reduce the Rate of Uric Acid Production

Allopurinol (Lopurin, Zurinol, Zyloprim) reduces the amount of uric acid in the blood and urine by slowing the rate of production of uric acid. It is the best medicine for people who have kidney problems or kidney stones caused by uric acid. Occasional side effects include skin rash and stomach upset. Infrequently, allopurinol can cause a  allergic reaction - skin rash, hives, itching, fever, nausea, and muscle pain are typical symptoms.

Medications that Help Eliminate Uric Acid

Some drugs lower the uric acid level by increasing the amount of uric acid passed in the urine. They help dissolve tophi and prevent uric acid deposits in joints. Probenecid (Benemid, Parbenem, Probalan) and sulfinpyrazone (Anturane). Common side effects include nausea, skin rash, stomach upset, or headaches. Increase water intake to about 10 x 8 ounce glasses per day. 

Avoid aspirin with these drugs because it blocks their effects on the kidneys. At first, probenecid or sulfinpyrazone may increase the risk of kidney stones by increasing the uric acid content in the urine. 

Adding baking soda to the water will make the urine more alkaline, increase the solubility of uric acid and help to reduce the risk of urinary tract stones.

Probenecid, sulfinpyrazone, and allopurinol also may cause more frequent gout attacks at first. You may have to take colchicine or an NSAID for the first few months of preventive drug therapy to prevent a gout attack.