Gout - Treatment

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NSAIDs, particularly aspirin, as well as other salicylate drugs, interfere with uricosuric drugs and reduce effectiveness. Patients who need minor pain relief should instead take acetaminophen (Tylenol). Uricosurics interact with many other drugs, and a patient should be sure to inform their health care provider of all medications they are taking.

Probenecid combined with allopurinol (another type of medicine that lowers uric acid levels) is available and may be beneficial in some cases.

Allopurinol (Lopurin, Zyloprim). Allopurinol blocks uric acid production. It is the drug most often used in long-term gout treatment for older patients and those who overproduce uric acid.

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Allopurinol is taken by mouth once a day in doses of 100 - 600 mg, depending on the patient's response to treatment. When it is first used, allopurinol can trigger further attacks of gout. Therefore, during the first months (or longer) of therapy, the patient also takes an NSAID or colchicine to reduce that possibility.

Allopurinol has positive effects on "bad" cholesterol levels, so it may be better than other drugs for patients with both gout and coronary artery disease.

Side effects, which can be severe, include:

• Rash
• Diarrhea
• Headache
• Fever
• Leukopenia (a reduction in the number of white blood cells)
• Thrombocytopenia (a reduction in the number of platelets)
• Cataracts

In rare cases, the rash can become severe and widespread enough to be life threatening (this condition is called toxic epidermal necrolysis, or TEN). Allergic individuals who experience only a mild rash may be able to build up their tolerance for the drug by undergoing a desensitization process.

Allopurinol interacts with certain other drugs, such as azathioprine.

Febuxostat. Febuxostat is the first oral drug to emerge in many decades as a new treatment for chronic gout. Approved by the FDA, it will be particularly useful for patients who are allergic to allopurinol. It is structurally distinct from allopurinol, but, like the older drug, it reduces uric acid production by inhibiting xanthine oxidase. For some patients, gout may flare up after starting the medication, then begin to resolve. The FDA continues to assess its potential for hypersensitivity. It is much more expensive than allopurinol.