Gout - Medications

Corticosteroids can be administered in different ways:

If only one joint is affected, an injection of the steroid triamcinolone directly into the affected joint can often bring rapid pain relief.
A single muscular injection of ACTH or triamcinolone may be the most rapid and reliable method for terminating an attack. Oral doses of prednisone are usually given for seven to 10 days after the injection in tapered doses. This is to prevent a rebound attack, which can occur after the injection.

These drugs should only be administered for short periods and not used for long-term treatment. Corticotropin (ACTH), a drug that converts to a steroid, is effective and safe, according to some evidence, but is not widely available.

Uricosuric Drugs

The uricosurics prevent the kidney from reabsorbing uric acid and so increase the amount excreted in the urine. They are usually the choice for preventing gout in the following patients:

Those under 60 years old
Those with normal diets
Those who have normal kidney function
Those who have no risk of kidney stones

Uricosuric drug candidates should produce no more than 700 to 800 mg of uric acid in urine over a 24-hour period.

Specific Uricosurics. Probenecid (Benemid, Parbenem, Probalan) and sulfinpyrazone (Anturane) are the standard uricosurics. A more potent uricosuric, benzbromarone,may work for people with severe tophaceous gout and renal impairment when other drugs do not. Insome studies, benzbromarone was equal to or even more effective than allopurinol, the other standard maintenance drug. Because it can cause liver failure in some patients, however, benzbromarone is available in the U.S. only with special authorization. A uricosuric combined with allopurinol may be beneficial in cases where using just one drug is not.

Probenecid is taken two to three times a day and sulfinpyrazone begins at twice a day and increases to three or four times daily. The initial doses should be low and then gradually built up. Probenecid combined with colchicine is more effective than probenecid alone, but patients respond differently to this regimen depending on the dosage balance, so it needs to be carefully individualized.

Side Effects. The possible side effects of these two drugs include skin rashes, gastrointestinal problems, anemia, and kidney stone formation. To help reduce acidity and the risk for kidney stones, patients should drink plenty of fluids (ideally water, not caffeinated beverages). Sodium bicarbonate supplemented by acetazolamide can also reduce acidity and the risk for stones.