Gout Meds

• What meds are available for tx of gout

  Colchicine, NSAIDs, Corticosteroids, Allopurinol, Probenecid
• Colchicine

  • Inhibits migration of neutrophils into the area of inflammation by binding to proteins in the microtubules of neutrophils, thereby interfering with the inflammatory response to urate crystal deposition; also blocks cell division by binding to mitotic spindles
  • n/v/d, abdominal pain, myopathy, neutropenia, aplastic anemia, alopecia (chronic use)
  • Dosage adjustment needed in pt taking CYP3A4 inhibitors
  • Oral, requires dosage adjustment in severe renal impairment, narrow therapeutic index
  • Tx acute gout attack, must be within 36 hours
• Monitoring for colchicine

  CBC, LFT, SCr, monitor hepatic/renal function
• Xanthine Oxidase Inhibitors: Allopurinol and Febuxostat


  • Purine analog that competitively inhibits the enzyme xanthine oxidase, leading to decreased production of uric acid
  • Well tolerated, skin rash (SJS, rare), hypersensitivity rxns (Han Chinese, Korean, Thai m.c), cardiovascular possible w/ Febuxostat
  • Requires dosage reduction for CrCl <50
  • Oral, has active metabolite leading to longer half life so only once daily dosing
  • Tx of chronic gout, useful in tx of gout/hyperuricemia secondary to other conditions like malignancies or renal disease
• Probenecid

  • Promotes renal clearance of uric acid by inhibiting the urate-anion exchanger in the proximal tubule that mediates urate reabsorption
  • Well tolerated, hypersensitivity, hepatic necrosis (rare), hematologic reactions (rare)
  • Oral, maintain adequate hydration to prevent kidney stones (keep urine alkaline which increases solubility of uric acid)
  • Tx chronic gout (alternative for XOI), may be used to increase levels of beta-lactam abx