Gout - Medications

Interactions. Adding low-dose colchicine or an NSAID may help prevent gout attacks, but NSAIDs, particularly aspirin, as well as other salicylate drugs, interfere with uricosuric drugs and reduce effectiveness, so they should be avoided if possible. Patients who require minor pain relief should instead take acetaminophen (Tylenol and others). Uricosurics interact with many other drugs, and a patient should be sure to inform the physician of any medications they are taking.

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Xanthine Oxidase Inhibitors

Allopurinol (Lopurin, Zyloprim) is a xanthine oxidase inhibitor that blocks uric acid production and is the drug most often used in long-term treatment for older patients and overproducers of uric acid (levels of excreted uric acid of more than 800 mg during a 14-hour period). It is also considered the drug of choice for patients with impaired kidney function, a history of kidney stones, and for tophaceous gout. Its use in patients with tophaceous gout can help reduce the need for later surgery.

Administration. Allopurinol is taken orally once a day in doses of 100 mg to 600 mg, depending on the patient's response to treatment. When it is first used, allopurinol can trigger further attacks of gout, and thus during the first months (or longer) of therapy the patient is also given a NSAID or colchicine to forestall that possibility.

Side Effects. Between 3 -5% of patients experience severe side effects including diarrhea, headache, and fever. Among the more serious are blood cell abnormalities, including leukopenia (a reduction in the number of white blood cells) and thrombocytopenia (a reduction in the number of platelets). The drug may also increase the risk for cataracts. About 2% of patients experience an allergic reaction to allopurinol that causes a rash. In rare cases, the rash can become severe and widespread enough to be life threatening (called Toxic epidermal necrolysis, or TEN). Allergic individuals who experience only a mild rash may be able to build up their tolerance for the drug by undergoing a desensitization process.

Of note: People with gout are at increased risk of atherosclerosis, or ?hardening of the arteries,? and coronary artery disease. A mechanism involving the metabolism of cholesterol plays a role in causing both atherosclerosis and gout. Because allopurinol has positive effects on ?bad? cholesterol levels, it may be better than other drugs for patients with both gout and coronary artery disease.

Interactions. Allopurinol interacts with certain other drugs, such as azathioprine.