Colchicine

Colchicine is given during a gout attack to relieve the pain, swelling, and inflammation. It works by decreasing the acidity of joint tissue and preventing deposits of uric acid crystals in joints. This medication may also be taken in smaller doses to help prevent recurrent gout attacks when people are started on urate-lowering medications.

Possible side effects include:

• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Muscle pain

Consult your doctor before taking colchicine if you have liver or kidney disease.

Corticosteroids

Common names include:

• Prednisone
• Prednisolone
• Betametasone (for joint injection)
• Triamcinalone (for joint injection)
• Methylprednisolone (given IV, usually for severe cases)

Corticosteroids can control the pain, swelling, and inflammation of joints caused by gout. The medication can be given as a tablet or in liquid form or by injection into a joint—or in severe cases, as an IV. If taken orally, corticosteroids are best taken at the same time(s) each day and should be taken with liquid or food to lessen stomach upset.

Possible side effects include:

• Indigestion, nausea, or vomiting
• Thrush
• Diarrhea
• Headache
• Psychiatric disturbances
• Weight gain
• Long term use may cause:
  • Glaucoma
  • Cataracts
  • Diabetes
  • Thinning of the skin
  • Weak, fragile bones
  • High blood pressure

Xanthine Oxidase Inhibitors

Common names include:

• Allopurinol
• Febuxostat

Xanthine oxidase inhibitors are sometimes given to people who suffer repeated gout attacks. This medication slows the development of uric acid by inhibiting the activity of certain enzymes. It's given in tablet form and should be taken at the same time(s) each day. Allopurinol should be taken with food or liquid to help avoid stomach upset. Febuxostat may be given if you cannot tolerate allopurinol or have kidney disease.

Possible side effects include:

• Rash
• Nausea
• Liver problems
• Joint pain (febuxostat)

Uricosuric Medications

Common names include:

• Probenecid
• Sulfinpyrazone
• Benzbromarone

These medications are sometimes given to those who suffer repeated gout attacks (especially when tophi deposits develop). This medication forces the kidneys to excrete additional uric acid. It's given in tablet form and should be taken at the same time each day with food or liquid to help avoid stomach upset. People with uric acid kidney stones or with certain blood disorders should not take these medications.

Possible side effects include:

• Headache
• Appetite loss
• Nausea
• Vomiting
• Kidney stones
• Lightheadedness (sulfinpyrazone)
• Severe rash from allergic reaction
• Ringing or buzzing in the ear—tinnitus (sulfinpyrazone)
• Flare-up of peptic ulcer (sulfinpyrazone)

Pegloticase

Pegloticase has been approved by the US Food and Drug Administration (FDA) to treat adults who have severe gout that has not been relieved by other treatments. This medication is an enzyme that works by turning uric acid into a chemical that does not cause gout symptoms. This chemical leaves the body through the urine. Pegloticase is given by injection every 2 weeks.

Since severe allergic reactions are common with this medication, a corticosteroid and an antihistamine are given before the injection of pegloticase. Other possible side effects include:

• Flare-up of gout
• Nausea and vomiting
• Constipation
• Bruise at the injection site
• Nasal irritation
• Chest pain
• Runny nose

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

• Ibuprofen—OTC or prescription
• Indomethacin—prescription only
• Naproxen—OTC or prescription
• Diclofenac—prescription only

NSAIDs are given to treat the pain, inflammation, and swelling caused by gout attacks. Some can be purchased over the counter or your doctor may prescribe a higher dosage. They work by decreasing prostaglandins, hormones that produce inflammation and pain. The medication may also be taken in smaller doses to help prevent attacks in those with recurrent gout attacks who are started on urate-lowering medications. NSAIDs are given by mouth. They should be taken at the same time (or times) each day and should be taken with food or liquid to help avoid stomach upset.

Possible side effects include:

• Stomach problems, such as stomach upset, ulcers, and bleeding
• Worsening of chronic conditions, such as high blood pressure, heart failure, or kidney disease
• Kidney damage
• Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes
• Increased risk of bleeding—always inform your doctor that you are taking an NSAID before having any medical or dental procedures or surgeries

NSAIDs may cause an increased risk of serious cardiovascular problems, like heart attack and stroke. This risk is especially important for those with cardiovascular disease or who are have risk factors for cardiovascular disease.