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Medicines to treat and prevent gout

Key points about gout medications

Medicines used for gout can be used to treat an attack of gout, or to prevent further attacks
The choice of medicine depends on other health conditions you may have such as kidney problems, heart failure, diabetes, stomach ulcers and other medicines you are taking.
Find out how to take gout medications safely and possible side effects.

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Gout attacks are also called flare-up or flares. They are associated with severe pain, redness and swelling of one or more joints. The big toe is most commonly affected.

In addition to resting the affected joint and using ice packs to reduce swelling, the following medicines can be used to manage the pain and swelling. The choice of medicine depends on other health conditions you may have such as kidney problems, heart failure, diabetes, stomach ulcers and other medicines you are taking.

Note: If treatment is started right away, relief from symptoms often occurs within 24 hours. Medicines for pain relief and swelling should not be taken long-term.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as naproxen, diclofenac (Voltaren) and ibuprofen reduces pain, swelling and redness quickly. Use the lowest dose for the shortest time – stop taking them once the pain and swelling has stopped.

NSAIDs should not be used in some situations, for example if you have heart failure, stomach ulcers, kidney problems. Read more about when you should not take NSAIDs. Always check with your healthcare provider if NSAIDs are safe for you.
NSAIDs can cause tummy problems such as indigestion and heartburn so take them with food. Read more about NSAIDs.
Note: Aspirin is not recommended for pain relief for gout as it can make your symptoms worse. But, if you are taking low-dose aspirin for a heart condition, continue taking it. Low dose aspirin does not increase your uric acid levels significantly.

Prednisone

Your doctor may prescribe a short course of prednisone tablets to reduce the pain and swelling.
Prednisone tablets are usually taken once daily until the attack has settled and the dose is reduced over 1 to 2 weeks before stopping.
Take prednisone tablets with food to reduce tummy upset.
Prednisone tablets are best taken in the morning because they can sleep problems. Read more about prednisone.

Colchicine

Colchicine is only used if you cannot take NSAIDs or prednisone because it can make you feel sick and cause diarrhoea. It is important to take the correct dose as there isn’t a big difference between a safe dose of colchicine and a harmful dose. Read more about taking colchicine safely.

If you have repeated attacks or flare-ups of gout, your doctor may recommend preventive medication. This helps to prevent further attacks and damage to your joints and organs such as your kidneys.

Because gout is caused by raised uric acid levels in the blood, preventive medications work by reducing uric acid levels. This is also called urate lowering therapy.

Medicines that limit the amount of uric acid your body makes

Examples: allopurinol and febuxostat.
How they work: These medicines limit the amount of uric acid your body makes.
- Doses are started low and increased slowly depending on how well you tolerate them.
- It’s common to have flare-ups when you first start treatment with allopurinol. In time they will reduce and allopurinol will prevent flare-ups from happening. It’s really important to keep taking your allopurinol regularly.
- To reduce the risk of such acute flare-ups of gout your doctor may prescribe a small dose of colchicine, or an NSAID, for a few months after starting treatment with allopurinol or febuxostat.

Medicines that help remove uric acid from the body

Example: probenecid.
How it works:
- Probenecid improves your kidneys' ability to remove uric acid from your body.
- It is usually used if you cannot take allopurinol.
- You need to have good kidney function if you are taking probenecid.

As part of rongoā Māori, rongoā rākau (the use of a traditional plant remedy with healing properties) may be used to help treat flare-ups of gout. It may be in the form of a paste applied to the skin or plant material added to bathwater. If you are considering taking any oral herbal medicine, your doctor or pharmacist can check to see if it is safe to take with your medicines.

Taking medicines is an important part of treating and preventing gout. In this video, Healthify He Puna Waiora consumer representative and cultural advisor Merle Samuels shares tips for managing your medicines.

(Healthify He Puna Waiora, NZ, 2020)

Gout is a long-term condition which means that it is ongoing and you will need to take medicines every day for many years to stay well. Many people find this challenging. In this video Merle discusses how she looks after herself with her long-term conditions.

(Healthify He Puna Waiora, NZ)