problems with acute gout and gout prophylaxis
Last reviewed 07/2023
Pharmacological gout prophylaxis consists of either:
- allopurinol - most widely prescribed drug for gout prophylaxis in the UK, or,
- uricosuric agents:
- probenecid
- sulfinpyrazone
There are several issues concerning prophylactic treatment in patients with acute gout:
- prophylactic treatments should not be commenced during an acute attack of gout
- if a patient has an acute attack while taking prophylactic treatment then the prophylaxis is continued at the same dose and the acute attack treated as usual
- initiation of prophylaxis may precipitate an acute attack; this is prevented by co-administering an NSAID or colchicine until one month after normalisation of the uric acid level (usually about 3 months prophylaxis)
Reference:
- Drug and Therapeutics Bulletin (2004); 42(5):37-40.
- BNF 10.1.4