Gout - Medications

Other Agents

Hypertensive Agents. People with gout have a higher risk for high blood pressure. Some of the agents usedto treathypertension, such as thiazide diuretics,can increase the risk for gout attacks. Newer agents, such as losartan (an angiotensin II receptor antagonist), and amlodipine (a calcium channel blocker), may have beneficial effects on both high blood pressure and gout.

text continues below

InvestigativeAgents

Xanthine Oxidase Inhibitors. Febuxostat is the first drug to emerge in many decades as a potential new treatment for chronic gout. It may prove to be an alternative for patients who are allergic to allopurinol. Phase II trial data reported significant reductions in serum uric acid levels. The drug's manufacturer submitted a new drug application to the FDA in December 2004.

Urate Oxidase. Recombinant urate oxidase (rasburicase) is being investigated for treatment ofhyperuricemia in adult and pediatric cancer patients. In a Phase II trial, pegylated urate oxidase (Puricase) dramatically decreased uric acid levels in patients with severe, refractory gout. Both drugs are administered by injection.

COX-2 Inhibitors. Etoricoxib (Arcoxia) is being investigated as a treatment for acute gout. However, the FDA has delayed approval of etoricoxib pending safety considerations. Etoricoxib is a successor to the COX-2 inhibitor rofecoxib (Vioxx) which was withdrawn from the market in 2004 due to substantial cardiovascular (heart attack and stroke) risks. The FDA is currently evaluating all COX-2 inhibitors to determine their relative risks versus benefit.

Alternative Agents

Some people use herbalor other natural remedies for gout. Patients should be very cautious when using such agents and do so only after checking with their physicians.

Herbs and Supplements

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.

The following warnings are of particular importance for people with inflammatory disorders:

Comfrey. Comfrey is a herbal remedy commonly used for a number of inflammatory problems. There is recent evidence that comfrey can be toxic to the liver and animal studies have reported a possible cancer risk. It is banned in Canada and other countries but is widely available in the US.

Ginkgo. Although the risks for ginkgo appear to be low, there is an increased risk for bleeding at high doses and interaction with anti-clotting medications. Commercial ginkgo preparations have also been reported to contain colchicine, which is also used in gout. Patients should be aware of this possible ingredient.