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Home Formulary 10.0 Musculoskeletal and Joint Diseases 10.1 Drugs use in rheumatic diseases and gout 10.1.4 Gout 10.1.4.1 Acute attacks of gout

10.1.4.1 Acute attacks of gout

ChoiceDrugDosage
1st choices

NSAID (see 10.1.1  for choices, consider gastroprotection)

See BNF
or

Colchicine tablets 500 micrograms		See BNF
2nd choice Prednisolone 5mg tablets [off label]A short course such as 30-35 mg once a day for 3-5 days*

*other regiments may be used

Prescribing notes

  • Prescribe as per NICE NG219 Gout: diagnosis and management recommendations. See NICE visual summaries, NICE CKS: Gout and BMJ Gout: diagnosis and management – summary of NICE guidance
  • Acute episodes should be treated as soon as possible. Patients can be given a supply of acute treatment and advised to start it if they feel an attack coming on.
  • Assess lifestyle and comorbidities (including cardiovascular risk factors and chronic kidney disease (CKD).
  • Aspirin is not indicated for acute attacks of gout.

Cautions

  • Colchicine has a narrow therapeutic window and is extremely toxic in overdose. Patients at particular risk of toxicity are those with renal or hepatic impairment, gastrointestinal or cardiac disease, and patients at extremes of age – see MHRA.
  • Refer to 10.1.1 for NSAID prescribing notes.

 

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