Arthritis and Gout
How Is Gout Treated? continued...
Long-term treatment of gout (to prevent attacks) involves medicine that lowers uric acid levels, such as Benemid, Uloric, or Zyloprim. Low doses of colchicine are also used to prevent attacks. These drugs are recommended for people who have had multiple attacks of gout, kidney stones due to uric acid, or tophi. The goal of lowering the blood uric acid is to slowly dissolve deposits of uric acid in the joint.
Sudden lowering of the uric acid level may cause an attack of gout. To prevent attacks in people who are taking uric acid-lowering drugs, prednisone, colchicine, or an NSAID is temporarily prescribed.
In addition, uric acid-lowering therapy (with Benemid, Uloric or Zyloprim) is not started during a gout attack, since sudden lowering of the uric acid can cause a new attack or prolong an existing one.
The drug Krystexxa (pegloticase) has been approved for adults with long-standing chronic gout who do not improve with or cannot tolerate other treatments. Krystexxa does have some side effects. A quarter of the patients who participated in the clinical trials experienced a severe allergic reaction. The FDA recommends that health care providers provide patients a corticosteroid and an antihistamine to reduce the risk of an allergic reaction.
What Are the Side Effects of Gout Drugs?
Upset stomach, indigestion, and headaches are the most common side effects of anti-inflammatory NSAIDs. Taking these drugs with food can help reduce stomach upset. NSAIDs also can cause vomiting, constipation, ulcers, bleeding in the stomach, irritation of the liver, and kidney damage, although these side effects are less common. NSAIDs should be avoided in those with a history of bleeding stomach ulcers and weak kidneys.
Side effects of corticosteroids include weight gain, increased appetite, and mood swings. Corticosteroids can have serious side effects when taken for a long period of time. Possible serious side effects include osteoporosis (thinning of the bones), diabetes, high blood pressure, cataracts, and decreased resistance to infection.
Possible side effects from colchicine include diarrhea, nausea, and abdominal cramps. In high doses, colchicine can cause kidney failure, seizures, and failure of the bone marrow, which leads to low blood counts. High doses of colchicine should be used with caution, especially in patients with kidney or liver disease.
The most common side effects of Zyloprim or Benemid are upset stomach, diarrhea, headache or dizziness, and a skin rash. The development of a rash while taking Zyloprim should be reported to your doctor immediately; the drug will likely need to be stopped. The most commonly reported adverse events in Uloric's clinical trials include liver function abnormalities, nausea, rash, and joint pain.
Not everyone will develop side effects from gout medications. How often any side effect occurs varies from person to person. The occurrence of side effects depends on the dose, type of drug, concurrent illnesses, or other drugs the person may be taking.
Some side effects are more serious than others. Before any medication is prescribed, your doctor will discuss with you the potential benefits and risks of taking the medication.