problems with acute gout and gout prophylaxis

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Pharmacological gout prophylaxis consists of either:

  • allopurinol - most widely prescribed drug for gout prophylaxis in the UK, or,
  • uricosuric agents:
    • probenecid
    • sulfinpyrazone

There are several issues concerning prophylactic treatment in patients with acute gout:

  • prophylactic treatments should not be commenced during an acute attack of gout

  • if a patient has an acute attack while taking prophylactic treatment then the prophylaxis is continued at the same dose and the acute attack treated as usual

  • initiation of prophylaxis may precipitate an acute attack; this is prevented by co-administering an NSAID or colchicine until one month after normalisation of the uric acid level (usually about 3 months prophylaxis)


    1. Drug and Therapeutics Bulletin (2004); 42(5):37-40.
    2. BNF 10.1.4

Last reviewed 06/2022