Long term control of gout
See individual NICE guidance for drugs below
This is the drug of choice for prophylaxis. It should not be started during an acute attack but 1-2 weeks after the attack has settled. The initiation of allopurinol may precipitate an acute attack, so an NSAID or low dose colchicine (500mcg 1 - 2 times daily) should be used as a prophylactic and continued for at least 1 month after the hyperuricaemia has been corrected.
This is a non-purine, xanthine oxidase inhibitor licensed for the treatment of chronic hyperuricaemia in adults, in whom urate deposition has already occured (including a history, or presence of, tophus and/or gouty arthritis). Febuxostat has been approved by NICE for use in patients with gout where allopurinol is contraindicated or not tolerated, (but take great care if the patient has a history of hypersensitivity to allopurinol - see warning above).
Crystallisation of urate in the urine can occur with uricosuric drugs below, therefore it is important to ensure adequate urine output in the first few weeks of treatment.
Aspirin and other salicylates antagonise uricosuric drugs, and so are not indicated in gout.