Table 42: Potential approaches to treatment of acute gout in patients with heart failure
| Acute gouty attack - Therapy: Oral colchicine | ||
|---|---|---|
| Type of gout | Dosage and duration of therapy | Dosage adjustment |
| Any type |
1.0-1.2 mg then 0.5-0.6 mg every 2 hours until pain relief with maximum of 3 mg per 24-hour period. May be used to abort gouty attack if used early enough |
Not recommended for GFR < 15 mL/min High rate of diarrhea with aggressive dosing. Many will use only a single dose of 0.6 mg after first dose |
| Acute gouty attack - Therapy: Oral prednisone | ||
|---|---|---|
| Type of gout | Dosage and duration of therapy | Dosage adjustment |
| Polyarticular gout, or inability to treat with colchicine | Prednisone, 0.5 mg/kg daily with rapid taper over 7-14 days |
No adjustment needed Can be given intravenously or orally and might not worsen acute HF |
| Acute gouty attack - Therapy: IA steroid injection | ||
|---|---|---|
| Type of gout | Dosage and duration of therapy | Dosage adjustment |
| IA steroid injection | Monoarticular gout. Not suitable for polyarticular gout | IA triamcinolone 20 mg once IA cortisone 100 mg once |
| Chronic prevention of gouty attacks - Therapy: Colchicine | ||
|---|---|---|
| Type of gout | Dosage and duration of therapy | Dosage adjustment |
| Can reduce attack frequency | 0.6 mg daily or twice per day in function of GFR | Not recommended for GFR < 15 mL/min |
| Chronic prevention of gouty attacks - Therapy: Allopurinol | ||
|---|---|---|
| Type of gout | Dosage and duration of therapy | Dosage adjustment |
| First-line agent for reduction of uric acid | 300 mg daily orally | Dose reduction for renal disease. 200 mg daily for GFR < 30 mL/min 100 mg daily for GFR < 20 mL/min 50 mg daily or 3 times weekly if ESRD |
| Chronic prevention of gouty attacks - Therapy: Probenecid | ||
|---|---|---|
| Type of gout | Dosage and duration of therapy | Dosage adjustment |
| Second- or third-line agent | 250 orally twice per day to maximum 1000 mg twice per day | Multiple drug interactions Avoid if GFR < 30 mL/min |