Gout Treatments

GOUT TREATMENTS
Non-pharmacologic therapy includes lifestyle and dietary changes such as weight management, reduced alcohol intake and consumption of high purine foods (ex. anchovies, asparagus, game meats, gravy, herring, liver, mackerel, mushrooms, sardines, scallops), as well as maintenance of blood pressure and lipid control.
Generic	Brand	Strength	Form	Adult Dose
Acute Attack
colchicine	Colcrys	0.6mg	tabs	1.2mg at first sign of gout flare, then 0.6mg 1hr later; max 1.8mg over 1hr period. May be given during prophylaxis at max 1.2mg at first sign of flare, then 0.6mg 1hr later; wait 12hrs, then resume prophylactic dose.
indomethacin	—	25mg, 50mg	caps	50mg 3 times daily until pain tolerable; then rapidly reduce dose to discontinue.
	—	50mg	supp
	Indocin Susp	25mg/5mL	susp
naproxen	Naprosyn*	500mg+	tabs	750mg once, then 250mg every 8hrs.
	Naprosyn*	125mg/ 5mL	susp	750mg once, then 250mg every 8hrs.
	Aleve	220mg	tabs, caplets, gelcaps, liquid gels	≥12yrs: 220mg every 8–12hrs; max 3 tabs/day. Initially, may give 440mg as 1st dose.
	Anaprox DS	550mg+	tabs	825mg once, then 275mg every 8hrs.
	Naprelan	375mg, 500mg, 750mg	controlled release tabs	1–1.5g once daily for 1 day, then 1g once daily until attack subsides.
prednisone	—	1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg	tabs+	Individualize. Initially 5–60mg daily.
		5mg/5mL	soln
		5mg/mL	intensol
	Rayos	1mg, 2mg, 5mg	del-rel tabs
sulindac	—	150mg+, 200mg+	tabs	Take with food. 200mg twice daily, usually for 7 days; max 400mg/day.
Chronic/Management/PROPHYLAXIS
allopurinol	Zyloprim	100mg+, 300mg+	tabs	Take with food. Initially 100mg daily; increase by increments of 100mg/day at weekly intervals. Usual range (mild): 200–300mg/day; (severe): 400–600mg/day. Max 800mg/day and 300mg/dose.
colchicine	Colcrys	0.6mg	tabs	>16yrs: 0.6mg once or twice daily; max 1.2mg/day.
	Gloperba	0.6mg/5mL	oral soln	0.6mg once or twice daily; max 1.2mg/day.
	Mitigare	0.6mg	caps	0.6mg once or twice daily; max 1.2mg/day.
colchicinum 4X–	Colcigel	0.25mL/pump actuation	gel	>16yrs: Apply 1–3 pumps (0.25mL–0.75mL) twice daily; max 6 pumps (1.5mL) in 24hrs.
febuxostat	Uloric	40mg, 80mg	tabs	≥18yrs: initially 40mg once daily. If serum uric acid is not <6mg/dL after 2wks, may increase to 80mg once daily. Severe renal impairment: max 40mg daily. Give gout flare prophylaxis (eg, NSAID, colchicine) upon initiation and for up to 6mos.
pegloticase	Krystexxa	8mg/mL	soln for IV infusion after dilution	Discontinue oral urate-lowering agents before starting. Premedicate with antihistamines and corticosteroids. Infuse over ≥2hrs. ≥18yrs: 8mg once every 2wks, co-administered with weekly oral methotrexate 15mg and folic/folinic acid supplementation (start methotrexate and folic/folinic acid at least 4wks prior to initiation). May give pegloticase as monotherapy if methotrexate is contraindicated or not clinically appropriate.
probenecid	—	500mg+	tabs	Take with plenty of fluids. 250mg twice daily for 1wk, then 500mg twice daily.
probenecid/ colchicine	—	500mg/ 0.5mg+	scored tabs	Take with plenty of fluids. 1 tab daily for 1wk, then 1 tab twice daily.
NOTES
Key: + = scored tabs; soln = solution; susp = suspension; supp = suppositories *EC-Naprosyn not recommended. Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 5/2023)

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