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Gout - Management
What drug treatment is recommended to prevent recurrent attacks of gout?

  • Start allopurinol after two or more attacks of gout within a year or after the first attack in people at higher risk with one or more tophi, X-ray features of gouty arthritis, renal impairment, known uric acid stones, or on long-term diuretic medication:
    • Start allopurinol 1–2 weeks after the inflammation has settled and titrate the dose every few weeks until the serum uric acid level is below 300 micromol/L.
    • Co-prescribe a low dose of nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose colchicine for a minimum of 6 weeks to prevent acute attacks of gout when starting allopurinol. Consider the need for gastroprotective medication when prescribing an NSAID.
    • If NSAIDs and colchicine are contraindicated, low-dose oral prednisolone once a day for 4 to 12 weeks is recommended.
  • Consider febuxostat as second-line therapy if allopurinol is not tolerated or contraindicated. The dose may be increased after 2–4 weeks if the SUA level remains above 360 micromol/L.
    • Co-prescribe a low dose of nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose colchicine for at least 6 months, to prevent acute attacks of gout when starting febuxostat. Consider the need for gastroprotective medication when prescribing an NSAID.
    • If NSAIDs and colchicine are contraindicated or not tolerated, low-dose oral prednisolone once a day for 4 to 12 weeks is recommended.

In depth

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