Problems with acute gout and gout prophylaxis

Pharmacological gout prophylaxis consists of either:

• allopurinol - most widely prescribed drug for gout prophylaxis in the UK, or,
• uricosuric agents:
  • probenecid
  • sulfinpyrazone

There are several issues concerning prophylactic treatment in patients with acute gout:

• prophylactic treatments should not be commenced during an acute attack of gout
  
  
• if a patient has an acute attack while taking prophylactic treatment then the prophylaxis is continued at the same dose and the acute attack treated as usual
  
  
• initiation of prophylaxis may precipitate an acute attack; this is prevented by co-administering an NSAID or colchicine until one month after normalisation of the uric acid level (usually about 3 months prophylaxis)

Reference:

1. Drug and Therapeutics Bulletin (2004); 42(5):37-40.

1. BNF 10.1.4