When should NSAIDS be used in the treatment of gout?

Updated: Feb 03, 2020
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

NSAIDs are the drugs of choice in most patients with acute gout who do not have underlying health problems. Although indomethacin is the NSAID traditionally chosen for acute gout, most of the other NSAIDs can be used as well. Select an agent with a quick onset of action. Do not use aspirin, because it can alter uric acid levels and potentially prolong and intensify an acute attack. Low-dose aspirin alters uric acid levels, increasing the risk of gout attacks and requiring close uric acid monitoring when aspirin is added to a uric acid/gout treatment regimen. [136]

Cyclooxygenase-2 (COX-2) inhibitors have been used with success, but patients may require higher dosages than are typically used. [137]

Avoid NSAIDs in patients with a history of peptic ulcer disease or gastrointestinal (GI) bleeding, those with renal insufficiency or abnormal hepatic function, those taking warfarin (a selective COX-2 inhibitor can be used), and those in the intensive care unit (ICU) who are predisposed to gastritis. Limit NSAID use in elderly patients, because of the potential for adverse central nervous system (CNS) effects. Use NSAIDs cautiously in patients with diabetes and those who are receiving concomitant angiotensin-converting enzyme (ACE) inhibitors.


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