Page "Gout" Paragraph 26

A number of medications are useful for preventing further episodes of gout, including xanthine oxidase inhibitor ( including allopurinol and febuxostat ) and uricosurics ( including probenecid and sulfinpyrazone ).

They are not usually commenced until one to two weeks after an acute attack has resolved, due to theoretical concerns of worsening the attack, and are often used in combination with either an NSAID or colchicine for the first three to six months.

They are not recommended until a person has had two attacks of gout, unless destructive joint changes, tophi, or urate nephropathy exist, as medications have not been found cost effective until this point.

Urate-lowering measures should be increased until serum uric acid levels are below 300 – 360 µmol / l ( 5. 0-6. 0 mg / dl ), and are continued indefinitely.

If these medications are being used chronically at the time of an attack, discontinueation is recommended.

If levels cannot be brought below 6. 0 mg / dl and there are recurrent attacks, this is deemed treatment failure or refractory gout.

Overall, probenecid appears less effective than allopurinol.