Gout

Side effects of gout medication

There are two main types of treatments for gout – medications to treat the pain and inflammation caused by an attack, and treatments to prevent attacks and long-term problems. Many people take these medications without having any side-effects.
Medication to treat the pain and inflammation

Some people took painkillers like paracetamol or co-codamol (paracetamol and codeine). No one we spoke to had noticed any side effects from these tablets. 
People who took non-steroidal anti-inflammatories (NSAIDs), like naproxen and diclofenac, were often aware that these could cause side effects like stomach upsets or damage the lining of the stomach. Most people had not noticed any side effects and some were taking drugs to prevent these problems (e.g. omeprazole or lansoprazole), or tablets like Arthrotec, that contain both an NSAID like diclofenac and a protective drug (e.g. misoprostol). 

Other side effects of NSAIDs include headaches, dizziness, rashes, aggravation of asthma, heart and kidney problems, and increased blood pressure. Simon would have liked more information about the possible side effects of the tablets he was prescribed. Some people had side effects when they were taking one medication so they had to change to another.
Colchicine is an effective drug for reducing inflammation during attacks, but it is well known for causing side effects of nausea and/or vomiting and diarrhoea when used in high doses. The risk of developing diarrhoea is reduced when lower doses are taken (e.g. one tablet every 6-8 hours) but it might take a bit longer for the medication to be effective. Doctors may prescribe an initial dose of two tablets to be followed by one tablet 3 or 4 times a day until the inflammation reduces and/or until side effects become difficult to manage, although side effects are more likely when such high doses are used. Some people we spoke to did not find the side effects too bad, but for others they were as bad or worse than the attack itself.
Some people had been warned about the side effects of colchicine by their doctor or pharmacist, but others had not. Val read about them in the leaflet that came with the tablets. She stopped taking colchicine before her gout symptoms had eased because she did not want the side effects to continue. Kate did not feel like eating after she took colchicine – she eventually went into hospital because she became unwell. Harry felt that putting up with the diarrhoea was ‘far better than having gout’.
Side effects of short courses of steroids like prednisolone are usually minimal (e.g. a minor impact on sleeping). However, long-term treatment should be used with caution because it can lead to weight gain, fluid retention, high blood pressure, diabetes and osteoporosis. Dee noticed that she put on weight while taking steroids. 
Medication to prevent attacks and long-term problems

Most people we spoke to had no side effects from the daily medication they took to prevent attacks and long-term problems. Some, though, did find that starting daily medication triggered an attack. Daily NSAIDs or colchicine can be taken to suppress inflammation when first taking daily preventative treatment. It can take up to 2 years for crystals to be completely cleared from the body, so people may continue having attacks during this time. (For more see ‘Long-term treatment to lower uric acid and prevent gout attacks and long-term problems’).
Serious side effects from allopurinol are rare – the majority of people do not have any problems but the most common side effect is a skin rash. This is not serious but may mean people have to stop taking the tablets. Harry had a reaction to allopurinol. His skin became red and then peeled off like sunburn. His GP told him to stop taking the tablets and he now takes febuxostat as a daily preventative medication. Some people noticed other symptoms and were not sure if they were caused by their medication or not. Sam noticed that she felt thirstier since taking allopurinol. 
The most serious side effect is called ‘allopurinol hypersensitivity syndrome’, which also involves skin reactions as well as liver and kidney problems. Fortunately this is rare and only affects one in a thousand people treated with allopurinol [Zineh, Mummaneni, Lyndly, Amur, La Grenade, Chang, Rogers, and Pacanowski, 2011]. If people have any side effects from allopurinol such as a rash, nausea, headaches or indigestion, they should stop taking the tablets and ask their doctor for advice. Lower doses, and more caution when increasing doses, are needed for people who have kidney problems because they are at more risk of side effects. Gerald’s specialist changed his medication from allopurinol to febuxostat because of concerns about his liver and kidney function. Allopurinol can also affect some other tablets like warfarin and azathioprine, so people must tell their doctor if they are taking these drugs.
Some people were worried about taking daily medication because of concerns about side effects. (For more see ‘Thoughts about the future and long-term effects’). Vic started taking daily allopurinol after about ten years of painful attacks. He’d initially misunderstood what he was told and thought that it was likely to cause major side effects. He then found out that side effects were rare, and wished he’d known more at the start. Harry believes that if people were more aware of the long-term risks of not taking daily medication (e.g. joint damage and kidney problems) they would be more willing to try medication.



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Last reviewed December 2016
Last updated December 2016

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