Gout - Medications

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Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Nonsteroidal anti-inflammatory drugs (NSAIDs) block prostaglandins, the substances that dilate blood vessels and cause inflammation and pain. They are the drugs of choice for young, healthy adults without any other serious medical condition. NSAIDs are usually taken orally at their highest safe dosage as long as gout symptoms persist and for3 or4 days after. Low doses of NSAIDs may be used to prevent gout attacks, including in patients who are starting anti-hyperuricemic therapies.

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NSAIDs Used. There are dozens of NSAIDs available.

There are dozens of NSAIDs. The most common are the following:

Over-the-counter NSAIDs include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), ketoprofen (Actron, Orudis KT).
Prescription NSAIDs include ibuprofen (Motrin), naproxen (Naprosyn, Anaprox), flurbiprofen (Ansaid), diclofenac (Voltaren), tolmetin (Tolectin), ketoprofen (Orudis, Oruvail), dexibuprofen (Seractil), indomethacin (Indocin).

Indomethacin (Indocin) is typically the first choice for patients who have no medical conditions that would preclude its use. Usually2 to7 days of high-dose indomethacin will be sufficient to treat a gout attack. The first dose of indomethacin usually begins to act against the pain and inflammation within 24 hours and often much sooner.

Ibuprofen, naproxen, sulindac, or others are good alternatives, particularly for elderly patients who might experience confusion or bizarre sensations with indomethacin. (Aspirin is an NSAID, but is associated with a higher risk for gout and should be avoided.)

Regular use of even over-the-counter NSAIDs may be hazardous for anyone and has been associated with the following side effects:

Ulcers and gastrointestinal bleeding. This is the major danger with long-term use of NSAIDs. (indomethacin poses a higher risk than many others for this adverse effect.)
Increased blood pressure. Most NSAIDs appear to pose this risk, with higher risks observed with piroxicam (Feldene), naproxen (Aleve), and indomethacin (Indocin). (Sulindac has the smallest effect and aspirin as no risk.) People with hypertension, severe vascular disease, kidney, or liver problems and those taking diuretics must be closely monitored if they need to take NSAIDs.
May delay the emptying of the stomach, which could interfere with the actions of other drugs. The elderly are at special risk.
Dizziness.
Tinnitus (ringing in the ear).
Headache.
Skin rash.
Depression has also been noted.
Confusion or bizarre sensation (in some higher-potency NSAIDs, notably indomethacin).
As with acetaminophen, high daily doses of aspirin have been associated with an increased risk of kidney failure, although the risk remains low in those with healthy kidney function. Kidney abnormalities have been reported in people taking other NSAIDs as well, which resolve when the drugs are withdrawn. Any sudden weight gain or swelling should be reported to a physician. Anyone with kidney disease should avoid these drugs.
Patients with diabetes who take oral hypoglycemics may need to adjust the dosage if they also need to take NSAIDs because of possible harmful interactions between the drugs.