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Clinician’s Corner: Gout Drugs

Your Thompson Pharmacist can easily tell if a patient has a gout attack.  Usually an overweight male, hobbles into the pharmacy in a pair of slippers with the toe cut out! There are several treatment options to give this patient relief.

TREATMENT OF ACUTE GOUT ATTACKS

Ground Rules for Drug Therapy

  • Goal of acute treatment is to relieve pain and inflammation. The “villain” is monosodium urate crystals.
  • Gout prevention medications (discussed next week) should not be started until the attack is over.

BENEFITS AND RISKS OF PHARMACOLOGICAL THERAPY

  • Even without treatment attacks of gout will end in 3 to 10days.
  • The goal of therapy is to relieve pain.
  • Use gout prevention drugs if patient has 2 or more attacks per year.
  • Long term goal of therapy is to prevent acute attacks.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

NSAIDS are a reasonable option in patients who do not have decreased kidney function or stomach ulcers.  Indomethacin (Indocin) a prescription drug was approved in June 1965, and due to adverse GI effects, is only used for treatment of acute gout flares.  There is no convincing evidence that it is any more effective than other NSAIDS, such as Ibuprofen (Motrin, Advil), Naproxen (Naprosyn, Aleve) or celecoxib (Celebrex).  For cardiac patients naproxen is the safest choice of the NSAIDS.

NSAIDS should be dosed as soon as onset of symptoms and taken on a consistent basis, not as needed until resolution of the acute gout flare.  Ibuprofen and Naproxen can be purchased without a prescription.  Ask your Thompson Pharmacist for help!

CORTICOSTEROIDS

Instead of NSAIDs for acute gout- just as effective for pain relief and are sometimes better tolerated.

Recommended dose: Prednisone 30 to 60 mg/day for acute gout until symptoms resolve. May take 5 to 7 days. Tapering the dose is not necessary at this dose and duration

Adverse effects: Patients with diabetes monitor should blood sugars more frequently.  May also cause fluid retention, high blood pressure and psychological adverse effects.

COLCHICINE (Colcrys®)

MECHANISM OF ACTION:  Reduces the body’s inflammatory response to the deposited crystals. Although it is anti-inflammatory, it does not relieve pain. 

INDICATIONS FOR USE

  • Specifically indicated for treatment and relief of pain in acute attack
  • Recommended for prevention between attacks
  • Effective in aborting an attack at the first sign of joint discomfort.
  • If used for acute flare, must be started within 36 hours

Acute attack: COLCRYS instructions: 1.2 mg (2 tablets) at the first sign of the flare followed by 0.6 mg (1 tablet) one hour later. The maximum recommended dose for treatment of gout flares is 1.8 mg over a 1-hour period. (3 tablets maximum).

Gout prevention dosing: 1-2 tablets per day for the first six months of urate lowering therapy. Colchicine can be used until the gout prevention drugs “kick in” and lower the uric acid levels.

WARNINGS/PRECAUTIONS/ADVERSE EFFECTS

  • Nausea, vomiting and diarrhea and bloating occur in up to 80% of patients.
  • Patients with active peptic ulcer disease should not use this drug

DRUG INTERACTIONS:

There are numerous and serious drug interactions associated with colchicine.  Have your Thompson Pharmacist check your pharmacy medication list to make sure this drug is safe for you.

Go ahead and ASK…at Thompson Pharmacy it’s all for YOU!