Gout medication: what stops the pain and what prevents it

Gout can go from a niggle to crippling pain in hours. The right medication can ease an attack quickly, while other drugs lower uric acid to cut down future flares. Below I’ll walk you through the common medicines, how they work, safety tips, and when to get medical help.

Acute gout: fast-acting options

When a flare hits, you want relief fast. Three main options are used:

- NSAIDs (ibuprofen, naproxen, indomethacin). These reduce inflammation and pain. Use as your doctor advises; high doses are common during flares and shorter courses are safer. Avoid if you have active stomach ulcers, severe kidney disease, or certain heart problems.

- Colchicine. Works well when started within 24–48 hours of symptom start. A common regimen is 1.2 mg first dose then 0.6 mg one hour later, then 0.6 mg once or twice daily until improvement — but follow your prescriber. Watch for diarrhea, nausea, and dose adjustments if you have kidney or liver problems.

- Corticosteroids. Oral prednisone or an injected steroid can calm severe attacks, especially if NSAIDs or colchicine are unsafe. Short courses usually control pain quickly but discuss glucose and mood effects with your doctor if you have diabetes or mental health concerns.

If you have fever, spreading redness, or can’t move the joint, seek urgent care to rule out infection or other problems.

Preventing future attacks: urate-lowering therapy (ULT)

Lowering long-term uric acid prevents gout. Common choices:

- Allopurinol. The most used ULT. Start low (often 100 mg daily) and slowly increase until uric acid target is reached. Regular blood tests check kidney function and liver enzymes. Allopurinol can interact with azathioprine and mercaptopurine — tell your prescriber about all meds.

- Febuxostat. An alternative when allopurinol isn’t suitable. It lowers uric acid effectively but needs monitoring for liver tests and possible cardiovascular risk in some patients.

- Probenecid. Works by helping the kidneys remove uric acid. Not suitable for people with certain kidney stones or poor kidney function.

Many doctors protect with a low-dose anti-inflammatory (colchicine or an NSAID) for the first months after starting ULT because changing uric acid can trigger flares.

Practical tips: get regular uric acid checks, adjust doses slowly, tell providers about kidney, liver, or heart disease, and review all medications (some diuretics raise uric acid). Lifestyle helps too: cut heavy alcohol, limit high-purine foods (like organ meats and some seafood), stay hydrated, and aim for steady weight loss if needed.

Want to start or change medication? Talk with a clinician who knows gout. They can pick the safest option for your other health issues and set a clear monitoring plan so you get fewer attacks and less pain.