| Acute Attack |
| Indomethacin |
Indocin
(Merck) |
Caps |
25mg
50mg |
• 50mg 3 times daily until pain relief;
rapidly taper and discontinue
|
• Use lowest effective dose and shortest
duration
• Discontinue if experiencing severe side effects
|
| Supp |
50mg |
Indocin Susp
(Iroko) |
Susp |
25mg/5mL |
| Naproxen |
Naprosyn
(Roche) |
Tabs |
250mg (scored)
375mg
500mg (scored) |
• 750mg followed by 250mg every 8 hours
until pain relief
|
• EC-Naprosyn not recommended
• Use lowest effective dose and duration
|
| Susp |
125mg/5mL |
Anaprox
(Roche) |
Tabs |
275mg |
• 825mg followed by 275mg every 8 hours until pain
relief
|
|
| Sulindac |
Clinoril
(Merck) |
Tabs |
150mg
200mg (scored) |
• 200mg twice daily until pain relief; usual duration
7 days
|
• Use lowest effective dose and shortest duration
• Take with food
• Max dose: 400mg per day
|
| Colchicine |
Colcrys
(URL Pharma) |
Tabs |
0.6mg |
• Gout treatment: 1.2mg at first sign of gout flare,
then 0.6mg 1 hour later; max 1.8mg over a 1 hour period; may be given during
prophylaxis at max 1.2mg at first sign of flare, then 0.6mg 1 hour later, wait
12 hours, then resume prophylactic dose. Concomitant CYP3A4 and/or
P-glycoprotein inhibitors, severe renal or hepatic impairment: reduce dose (see
literature).
|
|
| Prednisone |
Prednisone
(various) |
Tabs (scored) |
1mg
2.5mg
5mg
10mg
20mg
50mg |
• Individualize dose. Usually
5–60mg daily until pain relief; gradually taper
|
|
| Soln |
5mg/5mL |
|
| Intensol |
5mg/mL |
|
| Methylprednisolone |
Depo-Medrol
(Pfizer) |
Susp for inj |
20mg/mL
40mg/mL
80mg/mL |
• IA: Small joint: 4–10mg; medium joint:
10–40mg; large joint: 20–80mg
|
• Gently move joint after IA inj to aid mixing of
susp with synovial fluid
|
| Chronic/Management/Prevention |
| Allopurinol |
Zyloprim
(Prometheus) |
Tabs (scored) |
100mg
300mg |
• Initial: 100mg daily. Increase by increments of
100mg daily at weekly intervals until serum uric acid level ≤6mg/dL (minimizes
flare-ups)
• Mild: 200–300mg per day
• Severe: 400–600mg per day
|
• Take with food
• Ensure adequate fluid intake to yield ≥2 liters daily urine
output
• Maintain alkaline or neutral urine
• Administer in divided doses
• Max dose: 800mg per day and 300mg per dose
• Discontinue if rash appears
|
| Colchicine |
Colcrys
(URL Pharma) |
Tabs |
0.6mg |
• Gout prophylaxis: >16yrs: 0.6mg once or twice
daily; max 1.2mg/day. Concomitant CYP3A4 and/or P-glycoprotein inhibitors,
severe renal or hepatic impairment: reduce dose (see literature).
|
|
| Febuxostat |
Uloric
(Takeda) |
Tabs |
40mg
80mg |
• ≥18yrs: initially 40mg once daily; if serum
uric acid is not <6mg/dL after 2 weeks, may increase to 80mg once daily.
|
• Gout flare prophylaxis, with an NSAID or colchicine,
upon initiation of therapy and for up to 6 months, is recommended.
|
| Pegloticase |
Krystexxa
(Savient) |
Soln for IV infusion after dilution |
8mg/mL |
• 8mg once every 2 weeks
|
• Give by IV infusion over at least 2 hours and
premedicate with antihistamines and corticosteroids
• Slow rate, or stop and restart at lower rate, if infusion reaction
occurs; observe at least 1 hour post-infusion
|
| Probenecid |
Probenecid
(various) |
Tabs (scored) |
500mg |
• Initial: 250mg twice daily for 1 week
• Maintenance: 500mg twice daily
|
• Take with plenty of fluids
• Maintain alkaline or neutral urine
• Reduce dose if GI intolerance occurs
|
| Probenecid + Colchicine |
Probenecid + Colchicine
(various) |
Tabs (scored) |
Probenecid: 500mg
Colchicine: 0.5mg |
• Initial: 1 tablet daily for 1 week
• Maintenance: 1 tablet twice daily
|
• Take with plenty of fluids
• Maintain alkaline or neutral urine
• Reduce dose if GI intolerance occurs
|