Acute gout tx: NSAIDs or Colchicine?

[TexasTriathlete]

Which is it? I am seeing both, from different sources. What is the official word on this?

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[1nycdoc8]

Which is it? I am seeing both, from different sources. What is the official word on this?

I believe it's NSAIDs, specifically indomethacin... and definitely NOT ASPIRIN. The latter is completely contraindicated because it competes with renal excretion of uric acid.

 

[IHeartNerds]

Both are for acute episodes. However, NSAIDs are first line because they're much better tolerated. If you ever see a patient get Colchicine, you'll never forget why it's second-line therapy. No fun at all.

Indomethacin is always the answer offered, but in reality, naproxen and ibuprofen work as well. Start with high dosing.

 

[engineeredout]

From what we were taught Colchicine isn't the first line drug in acute gout because of toxicity.

 

[Doctor4Life1769]

1st line for acute = NSAIDs. Colchicine, while an option, isnt 1st line

Chronic: think allopurinol, probenecid, colchicine

 

[aa62]

treatment of acute gout episodes

1st line - indomethacin or naproxen.
2nd line - colchicine (ex: hx of NSAID hypersensitivity); major side-effect is ABDOMINAL DISCOMFORT and DIARRHEA.
contraindications - aspirin, allopurinol and probenacid.

treatment of chronic gout

1st line and when there is overproduction of uric acid (ex: chemotherapy patients) - allopurinol; be wary of co-administration with 6-mercaptopurine or other xanthine oxidase inhibitors.
2nd line and when there is decreased renal excretion of uric acid - probenacid.