Gout medications - an overview






Click on the text links to read more about each drug 

This page - gout medications - was last reviewed, or updated, on 30 October 2011 

The simple truth is that not one of the gout treatment medications works in all cases. The disease is very complicated and it just isn't well enough understood.

The standard long term gout treatment is to lower high uric acid levels by some method and hope that the reduction will dissolve the MSU gout crystals and tophi (if they have developed). Not so many people with high uric acid actually get gout. The level of uric acid is not everything in all cases.

It is frequently the case that lowering the serum (blood) uric acid level (the usual target is 6.0 mg/dL, (0.357 mmol/L) and maintaining the level below 6.0 mg/dL (0.357 mmol/L) will prevent a recurrent gout attack (flare up) and reduce tophi. And that is what gout sufferers want. The pharmaceutical industry is focused on reducing uric acid, by one way or another, as a long term gout treatment.

Click on the blue text links for each drug or class of drugs' name in the paragraph below to a single web page about each of these gout treatments. On each page, the first name used is the generic name. Many of the brand names are shown in brackets after the generic name.

Gout medications fall into two gout pain relief camps. Obviously the first thing to do for people is to reduce and eliminate pain and inflammation as soon as possible. The drugs which do this are: 

NSAIDs including Indomethacin and Diclofenac

Colchicine

Corticosteroids

Once pain and inflammation have subsided the next question is how can this problem be solved? Given that reducing uric acid is often successful, people are prescribed uric acid lowering drugs for long term gout treatment.  There are two routes that gout medications use. Lower uric acid production by the body and increase its excretion. 

Allopurinol is the most favoured current drug to lower its production; Probenecid and Sulfinpyrazone are the "main players" to increase its excretion. Unfortunately it's often hard to tell, especially in the early stages of treatment, whether someone is an over producer or under excretor.In any case not knowing this may not matter.

Allopurinol

Febuxostat

Febuxostat US FDA approval

Losartan

Pegloticase (Trade name Krystexxa)

The U.S.FDA approves Krystexxa (pegloticase)

More about the FDA approval on Krystexxa (pegloticase).

Urosuric (uricosuric) drugs - Probenecid, Sulfinpyrazone and Benzbromarone


The drawback of gout medications is that, like meds for other conditions, they can cause many different side effects (more accurately stated - cause other problems), allergic reactions, contraindications with other drugs and so on. That won't be news to you, but another drawback, is that patients who have other medical problems (kidney disease and heart disease of some kind are classic examples) will find their treatment options are reduced. So generally will the elderly. This is another reason why being otherwise healthy, apart from gout, is so important.  

Yet another major minus is that once gout medications have started, doctors recommend that they have to be continued. Some people will take gout medications for the rest of their lives. Others, for one reason or another, don’t continue with their gout treatment, often without even knowing their serum uric acid level. Initial high hopes fade into confusion, disappointment and an often justified disbelief in the medicine.

If you read a lot of what's on this website, you'll learn there are natural ways of reducing the serum (blood) uric acid level, but a cure for ever is never guaranteed. Once you have had a first gout attack, you need to be on guard against gout for the rest of your life.

More hope in the future

Allopurinol, one of the holy grail drugs for long term gout treatment, has been around for about 45 years. So too has the immediate pain relief drug Indomethacin. The meaning of this is that Allopurinol often works, and that the drug industry did not come up with anything better for the reduction of uric acid production for a long time.

Febuxostat was approved in early May 2008 for marketing in the European Union and in the United States in early 2009. It has since been made available in many places. Click here for a country list.

Another, Pegloticase (Krystexxa), was approved by the U.S.FDA and is now on the U.S. market. It was approved for the EU in early 2013. But in the autumn (fall) of 2013 its developers, Savient Pharmaceuticals, went into U.S. Chaper 11 bankruptcy protection. However funds have been made available to keep Krystexxa supplied. Savient hope to find a purchaser for their business.

There are some interesting others in the pipeline. Among these are Arcalyst which has been shown in trials to date to reduce the pain of gout attacks. It works by inhibiting a protein that's excreted by cells during gout attacks. (It has no effect on uric acid levels, it's for gout pain relief). It is not yet ready to apply for approval.

Another new gout medication to watch is RDEA594 In combination with 40 mg of febuxostat in a phase 2 trial, RDEA594 reduced average uric acid levels in trial participants down to an extraordinarily low 1.2 mg/dL (0.72 mmol/L). Getting uric acid down to 6.0 mg/dL (men) and 5.0 mg/dL(women) is considered the level at which people suffering gout may expect improvements. The trial participants were not gout sufferers, but a trial with gout sufferers is highly likely. RDEA594 encourages uric acid excretion - it doesn't inhibit its production.

Click here to read about new gout drugs under development

Notes on dosage 

When reviewing the pages for individual drugs the dosage figures should be used as a guide only. These dosage figures are not medical advice. Only your doctor can determine this. Generally doctors will prescribe the lowest dosage they think will bring about relief, or should be used for long term treatment. Generally they will increase that dosage if necessary, and taper it down as soon as they think it can be done.

Tip for taking medicine correctly 

It's a fact that people do not always take their medicines. Usually they have been forgotten. To help remember to take your gout medications as prescribed, take them at the same time each day. 

Click here to find out whether it is true that higher levels of uric acid, well above the level at which hyperuricemia is defined, make it harder to reduce uric acid levels to that number at which the MSU crystals dissolve. And what you should do if you have high levels of uric acid.

Want to read how it's possible to alleviate gout pain, or get gout pain relief from fish oils? Begin at our fish oils page



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