Indomethacin, and other NSAIDs, for fast acting gout pain reliefNSAIDs, which include indomethacin, are the first choice gout treatment for relieving immediate gout pain. They work by blocking the Cox -1 and Cox -2 enzymes which are vital for producing prostaglandins. One kind of prostaglandins, cause enlargement of blood vessels, an enlargement which causes pain and inflammation. NSAIDs may be given as part of long term gout treatment too. NSAIDs do not affect uric acid levels, and so don't dissolve the MSU gout crystals. Indomethacin is an NSAID and is mentioned separately from the others (below) because it's an important gout treatment. It has been used in gout treatment for over 40 years, which indicates it’s effective. It is gout medicine’s most widely used drug for immediate pain relief. Indomethacin is among the NSAID first choices for patients with no other medical conditions. Two to seven days of indomethacin usually halts or alleviates gout pain and some pain relief should occur after two to four hours. Thus indomethacin acts faster than colchicine - colchicine works for a majority of its users, usually after 12 hours. Dosage: Prescription (RX). Capsules, sustained release capsules, suppositories. (Suppositories are forms of a drug for people who cannot take a drug orally. They can be placed in the rectum and vagina). 100 – 200mg two or three times daily. Less as the attack subsides. Take with food to prevent stomach irritation. Possible side effects include: Lethargy; dizziness; mental confusion, nausea; vomiting; diarrhea; stomach pains; ulcers; gastrointestinal bleeding. WELL KNOWN NSAIDS Everyone has heard of some NSAIDs. They include aspirin (which should not be taken during a gout attack - it will worsen it ), ibuprofen, naproxen, diclofenac, indomethacin and others. Note that aminacetophin, aka paracetamol, (panadol, tylenol and others) is not a very effective gout attack reliever because it has no anti inflammatory effect. If you’ve had a gout attack, keeping an OTC NSAID (over the counter i.e. purchased without a prescription (RX)) is a good idea for an emergency. Carry your emergency treatment at all times of course. But most likely you’ll be taking a prescription NSAID for gout treatment. Carry that too. NSAIDs are usually prescribed as a gout treament for otherwise generally healthy people. But as with many other gout medications they may not be for the elderly and those with other medical conditions such as kidney disease and heart disease. Dosage: Take orally during the attack and for a few days after it. Dosages vary according to which NSAID is prescribed. eg. Naproxen (Naprosyn, Anaprox, Aleve, Artagen, Xenobid) 750 mg first tablet, then 250 mg subsequent tablets. or 500mg three times daily; Diclofenac (Voltaren) 50mg three times daily; Ibuprofen (Motrin) 800mg three or four times daily. If you are taking a non prescription NSAID make sure you follow the instructions on the packaging. They are there for good reasons. Possible side effects include: NSAIDs are generally well tolerated. But upset stomach, kidney damage diarrhea, headaches, elevated blood pressure, ulcers, gastrointestinal bleeding, and others are possible side effects. High dosages over longer periods can carry risk (possibly three people in 1,000 in one account) of heart attack and stroke. OTHER NSAIDS Two NSAIDs, valdecoxib (Bextra) and rofecoxib (Vioxx), both Cox -2 inhibitors, were taken off the market a few years ago because of concern about their side effects which included cardiovascular, high blood pressure and allergic reaction problems. Because they inhibited Cox -2 enzymes only it was thought they would avoid the side effects of Cox 1 and -2 blocking NSAIDs. Etoricoxib (brand name in most countries Arcoxia) has demonstrated that it can be more effective than Indomethacin for pain relief and it may have fewer side effects. It is mainly a Cox-2 inhibitor only, and therefore more selective than inhibitors such as indomethacin that inhibit both Cox-1 and -2. It is currently approved in over 60 countries, including those European countries that are members of the EU, (not all are). However, the European Medicines Agency (the EU version of the US FDA) and Britain's Medicine Safety Committee, issued new contraindications and cautions about its use 2005, as well as about other Cox-2 inhibitors. They were concerned about its potential for heart attacks, strokes and serious or even fatal skin reactions. But they did not request its withdrawl, judging that the benefits still outweighed the risks. In the U.S. the FDA, in April 2007, asked its manufacturers for more test results before any possibility of approval. Celecoxib (Celebrex) is also a Cox-2 only inhibitor. It is on sale in EU countries and the U.S. Celecoxib is currently the subject of a large study by its manufacturers to determine whether it has riskier cardiovascular effects than naxproxen or ibuprofen. The study will run till 2010.
You can visit the Celebrex website to read what its manufacturers advise.
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