Monday, June 15, 2015

Treatment for acute gout pain


Recommendation  
  • NSAIDs are the drugs of choice for acute gouty arthritis.
  • Colchicine is effective but is currently used less frequently because of its adverse effects
  • An oral low-dose colchicine regimen may be used in patients who are able to take an oral medication but who have contraindications to NSAIDs (eg, moderate or more severe chronic kidney disease [CKD], active peptic ulcer disease, or a history of NSAID-intolerance) 
NSAIDs (1st choice)
  • Naproxen: 500mg BD / Indomethcin: 50mg TDS
  • Prescribed for approximately a 7 to 10-day course or until 3-4 days after all signs of inflammation have resolved. 
COLCHICINE (2nd choice)
  • Recommended option in acute gout if the attack began within the past 36 hours. 
  • Loading dose:1.2 mg of colchicine followed by 0.6 mg 1 hour later. This can then be followed, 12 hours later, by prophylactic colchicine dosing 0.6 mg once or twice daily that may be continued until the gout attack resolves. 
  • If 1.0-mg or 0.5-mg tablets available, loading dose: 1.0 mg of colchicine followed by 0.5 mg 1 hour later. This can then be followed, 12 hours later, by prophylactic colchicine dosing 0.5 mg up to 3 times daily that may be continued until the gout attack resolves 
OTHERS (alternative if contraindicated)
  • In patients with contraindications to the use of both NSAIDs and colchicine, preference is for intraarticular, oral, or parenteral glucocorticoids, depending upon the number of involved joints.
*Notes
  • NSAIDs: Continue to take the medication throughout the attack and for 48 hours after the attack has finished 
  • NSAIDs should be prescribed together with a proton pump inhibitor (PPI), which reduces the risk of the NSAID causing indigestion, stomach ulcers and bleeding from the stomach. 
  • If have reduced kidney function, conditions such as stomach ulcers or bleeding, or who are using certain medications such as warfarin or treatments for blood pressure should avoid using NSAIDs.
REFERENCE:
http://emedicine.medscape.com/article/241767-treatment
http://www.uptodate.com/contents/treatment-of-acute-gout
http://www.nhs.uk/Conditions/Gout/Pages/Treatment.aspx
http://www.medscape.com/features/slideshow/gout#10


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