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