Gout medications - an overview

Click on the text links to read more about each drug medication

This page was last reviewed on 26 March 2010

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

The standard long term gout treatment i.e. lower uric acid levels by some method and hope that this will dissolve the MSU gout crystals and tophi (if they have developed) does not have a true theoretical underpinning because people who don’t have hyperuricemia can get gout and people who do have hypericemia don’t necessarily get gout. So the level of uric acid is not everything in all cases.

Nevertheless it is usually the case that lowering serum (blood) uric acid levels (the usual target is 6mg/DL, 357 mmol/L) and maintaining the level below 6mg/DL (357 mmol/L) will often 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
Pegloticase (Trade name Krystexxa)
Urosuric drugs - Probenecid, Sulfinpyrazone and Benzbromarone

The drawback of gout medications is that they can cause many different side effects (more accurately stated - cause other problems), allergic reactions, contraindications with other drugs and so on. 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 if long term gout treatment is managed at the best medications can make it.

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 in all cases. Once you have had a gout attack, you need to be on guard against gout for the rest of your life.

There’s more hope in the future for more people

Allopurinol, one of the holy grail drugs for long term gout treatment, has been around for about 40 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.

However the gout outlook is now (2010) brightening. Febuxostat was approved in early May 2008 for marketing in the European Union and in the United States in early 2009. Another, Pegloticase (Krystexxa), may be on the U.S. market in late 2010 and on European markets in 2011.

And 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 (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 forget to 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