First prescriptions for gout

This module covers medicines used in the management of gout. It discusses how to approach consultations with patients newly prescribed medication for gout, focusing on colchicine, allopurinol and febuxostat. 

Key facts

• Pharmacological management options for gout are split between treating the symptoms of an acute attack and trying to prevent future episodes. Colchicine and NSAIDs are predominantly used for the former, and allopurinol and febuxostat for the latter
• Colchicine has a narrow therapeutic index so careful dosing must be followed. The anti-inflammatory also has a significant number of interactions and side-effects, some of which may be sufficiently debilitating as to limit adherence
• Allopurinol and febuxostat are prescribed using a treat-to-target strategy, which involves regular serum urate testing. There are some significant cautions, contraindications and side-effects associated with both drugs.

Contributing author: Asha Fowells, MRPharmS MFRPSII, clinical pharmacy writer