Yes, there are several effective medications for gout, and they fall into two broad categories: drugs that stop the pain and inflammation of an acute flare, and drugs that lower uric acid over time to prevent flares from happening in the first place. Most people with recurring gout end up using both types at different points.
Medications for Acute Gout Flares
When a gout attack hits, the immediate goal is to shut down the inflammation caused by uric acid crystals in your joint. Three main options work well for this, and they’re roughly equal in effectiveness.
NSAIDs like ibuprofen and naproxen are often the first choice. Over-the-counter doses can help with mild flares, but most people need prescription-strength doses to get meaningful relief. These work best when taken at the first sign of an attack rather than hours into it.
Colchicine is an older drug that specifically targets the type of inflammation gout causes. The current recommended approach is 1.2 mg at the first sign of a flare, followed by 0.6 mg one hour later, for a total of 1.8 mg in that first hour. This lower-dose regimen works about as well as the older high-dose approach but causes far fewer stomach problems. Colchicine loses much of its effectiveness if you wait more than a day or two into a flare to start it.
Corticosteroids such as prednisone are a strong option when NSAIDs aren’t safe (for example, if you have kidney problems or stomach ulcers). They can be taken as pills, injected directly into the affected joint, or given as a muscle injection. A typical oral course starts around 30 to 40 mg daily and tapers down over 10 to 14 days.
For the rare cases where none of these work, injectable medications that block a specific inflammatory signal can be used, though they’re expensive and carry a higher risk of infection.
Medications That Lower Uric Acid Long-Term
Flare treatments only address symptoms. If you get gout attacks more than a couple of times a year, have visible uric acid deposits (tophi), or already have joint damage, you’ll likely be started on a daily medication to keep uric acid levels low enough that crystals stop forming.
The most commonly prescribed drug for this is allopurinol, which works by reducing the amount of uric acid your body produces in the first place. It’s taken daily, typically starting at a low dose and gradually increasing. The goal is to bring your blood uric acid level below 6 mg/dL (360 µmol/L), though your doctor will track your levels to find the right dose.
One important safety note with allopurinol: people of Southeast Asian, Korean, or Han Chinese descent have a higher risk of a rare but serious allergic skin reaction. Genetic testing for a specific marker (HLA-B*5801) is recommended before starting allopurinol in these populations, and also for Korean patients with reduced kidney function. Having kidney disease or taking certain blood pressure medications (thiazide diuretics) also raises the risk.
If allopurinol doesn’t work well enough or you can’t tolerate it, febuxostat is an alternative that works through the same mechanism. It’s taken once daily at 40 or 80 mg.
Drugs That Help Your Kidneys Remove Uric Acid
A second class of long-term medications takes the opposite approach: instead of reducing uric acid production, these drugs help your kidneys flush more uric acid out through your urine. They’re called uricosuric agents, and they work by blocking the proteins in your kidneys that normally reabsorb uric acid back into your bloodstream.
These medications are sometimes combined with allopurinol or febuxostat. Research has shown that combining drugs with complementary mechanisms produces significantly greater reductions in uric acid than simply increasing the dose of a single medication. This combination strategy is particularly useful if one drug alone isn’t getting your levels low enough.
Treatment for Severe, Refractory Gout
A small percentage of people with gout don’t respond to standard medications or can’t take them. For these cases, an IV infusion called pegloticase is available. It’s an enzyme that directly breaks down uric acid already circulating in the blood, and it’s reserved for chronic gout that has failed conventional therapy.
Pegloticase is given as a two-hour infusion every two weeks in a medical setting. Because it carries a risk of serious allergic reactions, patients receive antihistamines and corticosteroids before each infusion, and uric acid levels are checked beforehand. If levels rise above 6 mg/dL on two consecutive checks, the treatment is typically stopped. Patients on pegloticase also need to discontinue any oral uric acid-lowering medications while receiving infusions.
When Treatment Starts and How Long It Lasts
A common question is whether you can start a uric acid-lowering medication during an active flare. Current guidelines from the American College of Rheumatology say yes, you can begin it during a flare rather than waiting for the attack to fully resolve. However, starting these medications can temporarily trigger additional flares as uric acid crystals shift and dissolve. To prevent this, an anti-inflammatory medication like low-dose colchicine (0.6 mg once or twice daily) or an NSAID is typically continued alongside the new medication for three to six months.
For most people, uric acid-lowering therapy is a long-term commitment. Stopping it allows uric acid to build back up, and flares usually return. The medication itself is generally well tolerated once you’re on a stable dose, and the tradeoff is a dramatic reduction in painful attacks and joint damage over time.
How Much Can Diet Alone Do?
Lifestyle changes like reducing alcohol, cutting back on red meat and shellfish, staying hydrated, and losing weight can help lower uric acid levels. But for most people with established gout, diet alone doesn’t lower uric acid enough to prevent flares. Genetics play a larger role in uric acid levels than diet does, and medication is far more effective at reaching and maintaining the target range. That said, dietary changes complement medication well and can reduce the dose you need.