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In this essay we will discuss about the drugs used for the treatment of gout. The drugs are: 1. NSAIDs 2. Glucocorticoids 3. Colchicine 4. Allopurinol 5. Uricosuric Drugs.
Drug # 1. NSAIDs:
NSAIDs are the treatment of choice for acute gout due to ease of administration and low toxicity. Indometacin is very effective in relieving pain of acute gouty arthritis and is given in relatively large doses (50 mg orally 6-8 hourly) for 5 days to produce a rapid effect and then at reduced doses (25 mg 8 hourly) for 2-3 days.
Drug # 2. Glucocorticoids:
Glucocorticoids are useful when NSAIDs are contraindicated. An intra-articular injection of glucocorticoids produces rapid dramatic relief. Alternatively prednisone 40-60 mg once a day can be given until a response is obtained and then is tapered rapidly.
Drug # 3. Colchicine:
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Colchicine is an alkaloid obtained from the autumn crocus or meadow saffron. It is not an analgesic in true sense because it relieves only one type of pain, namely that associated with an acute attack of gout. It acts probably by inhibiting the actions of inflammatory cells in gouty tissue.
Colchicine is not commonly used because of its toxicity, and is only indicated when NSAIDs or glucocorticoids are contraindicated or not tolerated. It is given orally every 1-2 hourly until pain subsides or GI toxicity develops. Side effects include severe vomiting or diarrhea and long-term use may cause blood dyscrasias.
Drug # 4. Allopurinol:
Allopurinol slows the production of uric acid by inhibiting xanthine oxidase enzyme which is concerned with the synthesis of uric acid in the body. It is a well-tolerated drug and is widely used, especially in patients with renal impairment or with urate stones, where uricosuric drugs cannot be used. Skin rashes are particularly common and call for withdrawal of the drug. Hypersensitivity reactions occur rarely and can lead to all types of allergic reactions, which may be fatal.
Drug # 5. Uricosuric Drugs:
Probenecid and sulfinpyrazone increase the excretion of uric acid by the kidney. These drugs can be used instead of allopurinol or in combination in patients that are resistant to treatment. Side effects are mainly GIT upsets and skin rashes. Rarely hypersensitivity reactions and blood disorders may occur. Aspirin antagonises the action of uricosuric drugs and is not indicated in the treatment.
