Skip to Main Content Skip to Site Map Skip to Accessibility Statement Prophylaxis of gout

It is important to distinguish drugs used for the treatment of acute attacks of gout from those used in the long-term control of the disease. The latter exacerbate and prolong the acute manifestations if started during an attack.

1st choiceAllopurinol tablets 100mg, 300mg

2nd choice
(if inadequate response to maximum dose of allopurinol (900mg) or not tolerated

Febuxostat f/c tablets 80mg, 120mg

Prescribing Notes

  • Refer to NICE NG219 Gout: diagnosis and management and to the British Society for Rheumatology website for 2017 Guideline on the Management of Gout
  • Patients with gout often have increased cardiovascular morbidity and mortality. Underlying conditions such as hypertension, diabetes or renal impairment should be identified and the patient’s overall cardiovascular risk assessed.
  • In uncomplicated gout, uric acid lowering drug therapy should be started if a second attack or further attacks occur within 1 year.
  • Consider prophylaxis in patients who have had an attack of gout and who need high dose diuretics and monitor urate in patients with renal insufficiency.
  • Neither allopurinol nor febuxostat should be started during an acute attack, as they will increase its intensity. Usually wait 4 to 6 weeks after an acute episode before starting treatment.
  • Treatment should be continued indefinitely to prevent further attacks of gout by correcting the hyperuricaemia. These drugs must not be stopped during any acute gout flare ups.
  • Colchicine 0.5 mg twice daily should be co-prescribed following initiation of treatment with allopurinol or uricosuric drugs, and continued for up to 6 months. In patients who cannot tolerate colchicine, a NSAID can be substituted provided that there are no contra-indications. The NSAID should be continued until symptom control is achieved and the patient is stabilised
  • Analgesic doses of aspirin should be avoided. Low dose aspirin has the potential to precipitate gout; it should be reviewed and continued if indicated.
  • Allopurinol can cause rashes, including the rare and potentially life-threatening Allopurinol Hypersensitivity Syndrome (AHS).
  • The dose of allopurinol should be reduced in renal impairment:
    GFR 20 to 50mL/min: 200 to 300mg daily
    GFR 10 to 20mL/min: 100 to 200mg daily
    GFR < 10mL/min: 100mg daily or 100mg on alternate days
  • Febuxostat can be considered for patients who are intolerant of allopurinol or for whom allopurinol is contra-indicated. See NICE TA 164. Use with caution if eGFR <30mL/min
  • Allopurinol and febuxostat have important interactions with azathioprine and mercaptopurine and should not be prescribed together.

Recommendations for diet, lifestyle modification and non-pharmacological modalities of therapy

  • Refer to UK Gout Society Diet Factsheet for advice on healthy lifestyle choices in gout.


  • Caution is required if prescribing febuxostat in patients with pre-existing major cardiovascular disease, particularly in those with evidence of high urate crystal and tophi burden or those initiating urate lowering therapy- see MHRA
  • The MHRA drug safety update June 2012 detailed that febuxostat (Adenuric®) should be stopped if signs or symptoms of serious hypersensitivity (e.g. serious skin reactions or systemic hypersensitivity ) occur.


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