Drug regimens for acute gout
Graf, 2015Rainer, 2016Sivera, Andres, Carmona, 2014Sivera, Wechalekar, 2014Terkeltaub, 2010van Durme, 2014van Echteld, 2014Wechalekar, 2014Wechalekar, 2013
For advice on when to start pharmacological management for acute gout, see Management overview for gout. See Pharmacological management for acute gout for advice on how to choose drug therapy for an episode of acute gout.
For rapid symptom relief of acute gout with a corticosteroid, use:
1a local corticosteroid injection at up to 2 affected sites (see Principles of local corticosteroid injection use for musculoskeletal pain for advice on drug choice and example doses)
OR
1prednisolone (or prednisone) 15 to 30 mg orally, daily until symptoms subside (typically 3 to 5 days)1. prednis ol one prednis(ol)one prednis(ol)one
All of the NSAIDs listed below are equally effective and drug choice should be based on patient factors (eg comorbidities); see Choosing an NSAID for advice on drug choice. For rapid symptom relief of acute gout with an NSAID, use:
1celecoxib 100 to 200 mg orally, daily in 1 or 2 divided doses, until symptoms subside celecoxib celecoxib celecoxib
OR
1etoricoxib 30 to 60 mg orally, daily until symptoms subside etoricoxib etoricoxib etoricoxib
OR
1ibuprofen immediate-release 200 to 400 mg orally, 3 or 4 times daily until symptoms subside ibuprofen ibuprofen ibuprofen
OR
1indometacin 25 to 50 mg orally, 2 to 4 times daily until symptoms subside indometacin indometacin indometacin
OR
1ketoprofen modified-release 200 mg orally, daily until symptoms subside ketoprofen ketoprofen ketoprofen
OR
1meloxicam 7.5 to 15 mg orally, daily until symptoms subside meloxicam meloxicam meloxicam
OR
1naproxen immediate-release 250 to 500 mg orally, twice daily until symptoms subside naproxen naproxen naproxen
OR
1naproxen modified-release 750 to 1000 mg orally, daily until symptoms subside naproxen naproxen naproxen
OR
1piroxicam 10 to 20 mg orally, daily until symptoms subside piroxicam piroxicam piroxicam
OR
2diclofenac 25 to 50 mg orally, 2 or 3 times daily until symptoms subside. diclofenac diclofenac diclofenac
The use of colchicine for acute gout is limited by the short duration of treatment before toxicity occurs. Colchicine may be considered for patients who have previously used it to successfully manage an acute flare of gout. It is unlikely to be effective if not started within 24 hours of an attack. For rapid symptom relief of acute gout with colchicine, use:
colchicine 1 mg orally initially, then 0.5 mg 1 hour later, as a single one-day course (total dose is 1.5 mg). In addition, an NSAID (see dosage above) can be used for symptom relief until the flare resolves. colchicine colchicine colchicine
The low-dose regimen of colchicine recommended above is as effective as higher-dose regimens and is significantly safer. Ongoing NSAID therapy can be given until the flare resolves. Avoid colchicine in patients with kidney impairment. Colchicine is highly toxic and patients should be made aware of signs associated with colchicine toxicity (see Colchicine poisoning for further advice).