Which Medications Can Affect Gout?

which medications can affect gout

If you are like many American adults, you take multiple prescription medications each day to manage your chronic health conditions.1 Although these prescriptions may help to improve your overall health, you may not be aware of which medications can affect gout and increase your risk for gout flares.2

 

Urate-lowering therapy (ULT)

If you suffer with gout, you may take a ULT such as allopurinol, Uloric® (febuxostat), Zurampic® (lesinurad) or Krystexxa® (pegloticase).3-6 These medications have been shown to be a key part of long-term gout management because they can reduce the amount of uric acid in the bloodstream.3-6,7 However, it is important to understand that these medicines may cause gout flares.7 To minimize flares, the package inserts for these medications recommend the use of colchicine or non-steroidal anti-inflammatory drugs from the onset of treatment for as long as six months.3–6

 

Why ULTs can cause gout flares

As the ULT reduces the amount of uric acid in the bloodstream, urate crystals in the joints begin to dissolve.7 When the urate crystals start to dissolve, a gout flare can occur.7

The risk of ULT-related gout flares is highest in the first few months of treatment.3–6 However, certain medications may help prevent flares in gout patients who are beginning ULT.7

 

Preventing gout flares

The American College of Rheumatology (ACR) Guidelines for Management of Gout suggest that patients begin an anti-inflammatory medicine before or during ULT.8 Specifically, the ACR recommends low-dose colchicine (0.5 to 0.6 mg orally once or twice a day) as a first-line option for gout flare prevention.8 Research demonstrating the flare prevention benefits of adding colchicine to ULT date back as far as the 1960s.7

 

What other medications can affect gout?

In addition to ULT, a number of medicines have been shown to increase the risk of gout or worsen gout in patients who already have it.2,9-13 Some of these medicines are over-the-counter; others are available only with a prescription. These medicines include:

Diuretics2,9

Also known as “water pills,” diuretics help reduce the amount of fluid in your body by increasing how much you urinate. Doctors typically prescribe them to help reduce blood pressure, treat edema and manage heart disease. Because diuretics increase urination, the fluid that remains in your body is more concentrated and can put you at risk for developing the crystals that cause gout. Certain diuretics also reduce how much urate you pass in your urine, leaving you with more uric acid in your body, which can increase your risk of gout flares.

Salicylate-containing drugs2,10

Salicylate-containing drugs, including aspirin, can increase your risk for gout.2 Nearly one-third of middle-aged Americans (approximately 50 million people) take low-dose aspirin daily to help prevent cardiovascular disease.4 However, low-dose aspirin has been shown to reduce the amount of urate passed in the urine, resulting in an increase in the amount of uric acid in the body and a higher risk for gout.4

Niacin2,11

Also known as Vitamin B3 or nicotinic acid, niacin has been shown to increase the risk of gout.2 It is unclear whether this elevated risk is caused by an increase in the uric acid level or a reduction in the amount of uric acid passed in the urine.5

Cyclosporine2,12

Cyclosporine is used with other medications to prevent the rejection of a transplanted organ by the body’s immune system.2 It is believed that cyclosporine reduces the amount of urate passed in the urine, resulting in an increase in the amount of uric acid in the body and a higher risk of gout.6

Levodopa2,13

Levodopa, also known as L-dopa, is a medicine used to treat Parkinson’s disease. It is believed that either levodopa or one of its byproducts increases the risk of gout by raising the level of uric acid in the bloodstream.

 

Talk with your doctor

Be sure to tell your doctor about all of the medicines and supplements you take—both prescription drugs and over-the-counter products. Your doctor can tell you which medications can affect gout or raise your risk of gout flares, if any. Your doctor may also be able to recommend alternative treatments.

 

NOTE: This article was not written by a medical professional and is not intended to substitute the guidance of a physician. These are not West-Ward’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

All registered trademarks are the property of their respective owners.

References

  1. White Paper—What Is the Significance of a Color of a Pill? Wallcur, LLC website. Available at: http://www.wallcur.com/whitepaper-pill-color.aspx. Accessed February 28, 2018.
  2. NIH Medline Plus website. What Causes Gout? Available at: https://medlineplus.gov/magazine/issues/winter12/articles/winter12pg20.html. Accessed February 18, 2018.
  3. Allopurinol Tablets, USP [prescribing information]. Memphis, TN: Northstar Healthcare Holdings; 2016.
  4. Uloric® (febuxostat) [prescribing information]. Deerfield, IL: Takeda Pharmaceuticals America, Inc; 2013.
  5. ZURAMPIC® (lesinurad) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2015.
  6. KRYSTEXXA® (pegloticase injection) [prescribing information]. Lake Forest, IL: Horizon Pharma Rheumatology LLC; 2016.
  7. Aung T, Myung G, FitzGerald JD. Treatment approaches and adherence to urate-lowering therapy for patients with gout. Patient Prefer Adherence. 2017;11:795–800.
  8. Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. Arthritis Care Res (Hoboken). 2012;64:1447–1451 and 1456–1459.
  9. Mayo Clinic website. Diuretics and gout: What’s the connection? Available at: https://www.mayoclinic.org/diseases-conditions/gout/expert-answers/diuretics-and-gout/faq-20058146. Accessed February 18, 2018.
  10. Zhang Y, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi H. Low-dose aspirin use and recurrent gout attacks. Ann Rheum Dis. 2014;73(2):385–390.
  11. Song W-L, FitzGerald GA. Niacin, an old drug with a new twist. J Lipid Res. 2013;54(10):2586–2594.
  12. Lin H-Y, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox, IH. Cyclosporine-Induced Hyperuricemia and Gout. N Engl J Med. 1989;321:287–292.
  13. Calne DB, Fermaglich J. Gout induced by L-dopa and decarboxylase inhibitors. Postgrad Med J. 1976;52:232–233.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Columbus Inc., Columbus, OH 43228

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.