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Gout medications.....An overviewClick on the text links to read more about each drug medicationThe 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 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) and maintaining the level below 6mg/DL 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
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
Another major drawback is that once gout medications have started doctors recommend that they have to be continued. Many people, for one reason or another, don’t continue with their gout treatment. Initial high hopes fade into confusion, disappointment and an often justified disbelief in the medicine. 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 has not come up with anything better for the reduction of uric acid production. However the gout outlook is now (2008) brightening. Febuxostat was approved in early May 2008 for marketing in the European Union. A second, Pegloticase may be on the world market in 2009. And there are others in the pipeline. All tackle the uric acid problem by one route or another. The cure-all for gout remains elusive.
For more details see the section on new drugs.
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.
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