NHS Dudley Health Economy Medicines Formulary
Home > 10 Musculoskeletal and joint diseases > 10.1 Drugs used in rheumatic diseases and gout > 10.1.4 Gout and cytotoxic-induced hyperuricaemia

10.1.4 Gout and cytotoxic-induced hyperuricaemia

General guidance

 

  • It is important to distinguish between drugs used for the treatment of acute attacks from those used in the long-term control of the disease.
  • Acute attacks can be treated with high doses of NSAIDs such as indomethacin, or naproxen. Azapropazone should be avoided, its use been restricted to those in whom other NSAIDs have been ineffective.
  • Colchicine is probably as effective as NSAIDs. Its use is limited by adverse reactions at higher doses but it is especially useful in patients with heart failure and those receiving anticoagulation. Local advice is to use a maximum dose of 500 micrograms once or twice daily.
  • Frequent recurrence of acute attacks of gout may call for the initiation of long-term treatment.
  • Allopurinol and uricosurics are not effective in the acute attack and their use may prolong it indefinitely. They should not be used in acute attacks. Allopurinol may be introduced slowly no sooner than 4 weeks after any acute attack, consideration should be given to the use of colchicine to cover any acute flares.

 

Recommended drugs

Acute attacks

Colchicine

Indometacin 

Long term control of gout

Allopurinol

 

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

 

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low

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