GOUT TREATMENTS | ||||
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Non-pharmacologic therapy includes lifestyle and dietary changes such |
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Generic | Brand | Strength | Form | Adult Dose |
Acute Attack | ||||
colchicine | Colcrys | 0.6mg | tabs | 1.2mg at first sign of gout flare, then 0.6mg 1hr later; max 1.8mg over 1hr period. May be given during prophylaxis at max 1.2mg at first sign of flare, then 0.6mg 1hr later; wait 12hrs, then resume prophylactic dose. |
indomethacin | — | 25mg, 50mg | caps | 50mg 3 times daily until pain tolerable; then rapidly reduce dose to discontinue. |
50mg | supp | |||
Indocin Susp | 25mg/5mL | susp | ||
naproxen | Naprosyn* | 500mg+ | tabs | 750mg once, then 250mg every 8hrs. |
125mg/ 5mL |
susp | |||
Aleve | 220mg | tabs, caplets, gelcaps, liquid gels | ≥12yrs: 220mg every 8–12hrs; max 3 tabs/day. Initially, may give 440mg as 1st dose. | |
Anaprox DS | 550mg+ | tabs | 825mg once, then 275mg every 8hrs. | |
Naprelan | 375mg, 500mg, 750mg | controlled release tabs | 1–1.5g once daily for 1 day, then 1g once daily until attack subsides. | |
prednisone | — | 1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg | tabs+ | Individualize. Initially 5–60mg daily. |
5mg/5mL | soln | |||
5mg/mL | intensol | |||
Rayos | 1mg, 2mg, 5mg | del-rel tabs | ||
sulindac | — | 150mg+, 200mg+ | tabs | Take with food. 200mg twice daily, usually for 7 days; max 400mg/day. |
Chronic/Management/PROPHYLAXIS | ||||
allopurinol | Zyloprim | 100mg+, 300mg+ | tabs | Take with food. Initially 100mg daily; increase by increments of 100mg/day at weekly intervals. Usual range (mild): 200–300mg/day; (severe): 400–600mg/day. Max 800mg/day and 300mg/dose. |
colchicine | Colcrys | 0.6mg | tabs | >16yrs: 0.6mg once or twice daily; max 1.2mg/day. |
Gloperba | 0.6mg/5mL | oral soln | 0.6mg once or twice daily; max 1.2mg/day. | |
Mitigare | 0.6mg | caps | ||
colchicinum 4X– |
Colcigel | 0.25mL/pump actuation | gel | >16yrs: Apply 1–3 pumps (0.25mL–0.75mL) twice daily; max 6 pumps (1.5mL) in 24hrs. |
febuxostat | Uloric | 40mg, 80mg | tabs | ≥18yrs: initially 40mg once daily. If serum uric acid is not <6mg/dL after 2wks, may increase to 80mg once daily. Severe renal impairment: max 40mg daily. Give gout flare prophylaxis (eg, NSAID, colchicine) upon initiation and for up to 6mos. |
pegloticase | Krystexxa | 8mg/mL | soln for IV infusion after dilution |
Discontinue oral urate-lowering agents before starting. Premedicate with antihistamines and corticosteroids. Infuse over ≥2hrs. ≥18yrs: 8mg once every 2wks, co-administered with weekly oral methotrexate 15mg and folic/folinic acid supplementation (start methotrexate and folic/folinic acid at least 4wks prior to initiation). May give pegloticase as monotherapy if methotrexate is contraindicated or not clinically appropriate. |
probenecid | — | 500mg+ | tabs | Take with plenty of fluids. 250mg twice daily for 1wk, then 500mg twice daily. |
probenecid/ colchicine |
— | 500mg/ 0.5mg+ |
scored tabs | Take with plenty of fluids. 1 tab daily for 1wk, then 1 tab twice daily. |
NOTES | ||||
Key: + = scored tabs; soln = solution; susp = suspension; supp = suppositories (Rev. 5/2023) |
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