Gout - Medications

Arthrotec. Arthrotec is a combination of misoprostol and the NSAID diclofenac that may reduce the risk for gastrointestinal bleeding. One study found that patients taking Arthrotec had 65 - 80% fewer ulcers than those who took NSAIDs alone.

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Colchicine

Colchicine, a derivative of the autumn crocus (also called the meadow saffron), has been used against gout attacks for centuries. It is highly effective though no longer the first drug of choice because of its frequent, unpleasant, and sometimes very serious side effects.

Oral Regimen. The oral regimen requires doses every hour until the symptoms either improves or side effects develop; improvement should be evident by the tenth dose. Oral colchicine usually eliminates the pain of an acute attack within 48 hours.

The drug is generally appropriate only for healthy adults. It should not be used by elderly patients or those with kidney, liver, or bone marrow disorders. It can also affect fertility and should not be used during pregnancy.

Colchicine is unsuitable for many other patients as well, because of gastrointestinal side effects, which occur at the high doses necessary to relieve symptoms. They include nausea, vomiting, diarrhea, or abdominal cramps. Low doses do not pose as high a risk for gastrointestinal symptoms, and can prevent further attacks, including in patients who are starting anti-hyperuricemic therapies.Low dosescause virtually no GI side effects. Note: The antibiotic erythromycin or H2 blockers, such as famotidine (Pepcid AC), cimetidine (Tagamet), ranitidine (Zantac), may intensify the gastrointestinal side effects of colchicine. A 2004 study showed that long-term colchicine therapy may also weaken the respiratory muscles, especially among patients with renal failure. Colchicine also interacts with a number of other medications.

Intravenous. Intravenous administration of colchicine relieves episodes of gout without gastrointestinal effects and for a time, physicians hoped it could be used routinely. The intravenous route has some serious side effects, however, and poses an increased risk for injury to the kidney, liver, central nervous system, and bone marrow.

Warning Note: Overdose of colchicine can be dangerous, and there have even been reports of death. The agent may also suppress blood cell production and cause nerve and muscular injury in certain people, sometimes even in those not taking high doses.

Corticosteroids

Corticosteroids, known commonly as steroids, are used when patients cannot tolerate other anti-inflammatory drugs or they prove ineffective for an attack of gout. They are becoming popular in elderly people.