Names, not a prescription
Medicines, by name
These are names clinicians use. The choice is made with you. Not everyone can take each one. This site does not say which, or how much.
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Medicines for a flare
For a gout flare, clinicians commonly use colchicine, an NSAID (a nonsteroidal anti-inflammatory), or a steroid (a glucocorticoid). A steroid may be a pill, or sometimes an injection a clinician gives. The 2020 American College of Rheumatology guideline strongly recommends those kinds of anti-inflammatories. The 2016 EULAR recommendations name the same kinds of medicines for a flare.
Not everyone can take each one. Kidneys, stomach, bleeding risk, diabetes, other medicines, and pregnancy change the choice. Those facts are reasons to talk with a clinician. They are not reasons to pick “the other one” from a list on your own.
Do not start a leftover steroid, or anyone else’s prescription, because the name appeared here. Do not take more than a clinician who knows you has already told you to take. The longer version of the flare, including rest, ice, and elevation, is on During a flare. How the three flare options differ, qualitatively, is on Flare medicines compared.
Medicines that lower urate
Flare medicines calm inflammation. They are not the same job as medicines that lower urate over time. For repeated flares, tophi, or ongoing gout, NIAMS is direct: lifestyle changes alone are not enough when a clinician has said a urate-lowering medicine is needed.
Allopurinol is the usual first urate-lowering medicine in the 2020 ACR guideline, including when chronic kidney disease is present. Usual, in a guideline, is not a prescription with your name on it. Kidney function, other medicines, and a history of reactions still belong in that conversation. Not everyone can take it.
Febuxostat is another urate-lowering medicine. It exists. Whether it is appropriate for you is the clinician’s decision, not a ranking this page will finish. Other options exist for severe disease. Those are also decided with the clinician. This page does not name a winner, and it does not say who should switch.
| Job | Names clinicians use | What this page will not do |
|---|---|---|
| A flare | Colchicine, an NSAID, or a steroid (a pill, or sometimes an injection). | No dose, no schedule, and no advice to use someone else’s supply. |
| Long term | Allopurinol is the usual first in the ACR guideline, including when chronic kidney disease is present. Febuxostat exists. Other options exist for severe disease. | No starting amount, no titration, and no reason to switch on your own. |
Do not start allopurinol, febuxostat, or any other urate-lowering medicine from a bottle in a drawer. Starting, stopping, and switching are clinician decisions.
Treat-to-target is a blood-test strategy
The blood test is how the plan is judged over time. Feeling well between flares does not replace it. How a clinician reaches a diagnosis, including why one blood test during a flare is not a yes-or-no, is on How gout is diagnosed.
Flares can still happen after you start
Starting or changing a urate-lowering medicine can be followed by flares. That is a known pattern. It is not proof the medicine failed, and it is not a reason to quit on your own. Call the clinician who knows you. Ask what they want you to do for this flare. The 2020 ACR guideline conditionally recommends continuing urate-lowering medicine indefinitely over stopping it, as a long-term plan. Ask your clinician before changing anything.
Clinicians often pair the start with an anti-inflammatory for a time. Which drug, and for how long, is theirs. There is no schedule on this page. The early stretch is described, still without a calendar, on The first months.
What this page refuses
Do
- Make the choice with a clinician who knows your kidneys, stomach, bleeding risk, diabetes, other medicines, and pregnancy if it applies.
- Ask that clinician before changing a urate-lowering medicine during a flare. As a long-term plan, the 2020 ACR guideline favors continuing it indefinitely over stopping it.
- Call if flares show up after a start or a change.
Don’t
- Look here for a dose, a titration, or a target number.
- Start, stop, or switch because a name was listed.
- Treat a vinegar, baking-soda, or herbal flush as a medicine.
Nothing on this page dissolves crystals at home, and nothing here is a plan you can finish without the clinician.
Clinical claims on this page follow the sources.