Gout is treated with two distinct categories of medicine: anti-inflammatory drugs that stop a painful flare quickly, and uric acid-lowering drugs taken daily to prevent future attacks. Most people with recurring gout need both. The specific combination depends on how frequent your flares are, your kidney function, and which medications you tolerate well.
Medicines for an Acute Gout Flare
When a gout attack strikes, the goal is to reduce inflammation as fast as possible. Three types of medication are used, and the key with all of them is starting early. Treatment works best when you take it at the very first sign of a flare, not after the pain has fully set in.
Colchicine is one of the most commonly prescribed options for acute gout. The standard approach is a dose of 1.2 mg at the first sign of an attack, followed by 0.6 mg one hour later. That’s it for the first day. Colchicine is highly effective when taken within the first 12 to 24 hours of symptoms, but it becomes less useful the longer you wait. Side effects are mostly gastrointestinal: nausea, diarrhea, and cramping, which are more common at higher doses.
NSAIDs (nonsteroidal anti-inflammatory drugs) like naproxen and indomethacin are another first-line choice. They work by broadly reducing inflammation in the joint. NSAIDs are typically taken at full dose for the first few days, then tapered as the flare resolves. They’re not ideal if you have kidney disease, stomach ulcers, or are on blood thinners.
Corticosteroids are the go-to when someone can’t take colchicine or NSAIDs. Oral prednisone is the most common form, though a steroid injection directly into the affected joint is another option. Corticosteroids are effective and fast-acting, but they come with side effects like blood sugar spikes and fluid retention, which matter more for people with diabetes or heart failure.
With any of these treatments, most flares improve substantially within a few days and fully resolve within one to two weeks.
Medicines That Prevent Future Attacks
If you’ve had more than one or two flares, or if you have visible uric acid deposits (called tophi), your doctor will likely recommend long-term urate-lowering therapy. These medications reduce the amount of uric acid in your blood, which is the root cause of gout. The clinical target is a uric acid level below 6 mg/dL. Reaching that number makes a dramatic difference: people with uric acid above 9 mg/dL have flares roughly six times more often than those at or below the target.
Allopurinol is the most widely prescribed urate-lowering drug. It works by blocking the enzyme that produces uric acid. It’s typically started at a low dose and gradually increased over weeks or months until your uric acid level hits the target. This slow titration reduces the risk of triggering a flare during the adjustment period.
One important safety note: people of Southeast Asian descent (including Han Chinese, Korean, and Thai populations) and African American patients are recommended to undergo genetic testing for a specific gene variant called HLA-B*5801 before starting allopurinol. Carrying this variant significantly increases the risk of a rare but severe allergic skin reaction. Testing is simple and can guide your doctor toward a safer alternative if needed.
Febuxostat works by the same mechanism as allopurinol but is a different chemical compound. The FDA has limited its approval to patients who haven’t responded to allopurinol or can’t tolerate it, partly due to concerns about cardiovascular risk at higher doses. It’s an effective backup option but not a first choice for most people.
Probenecid takes a completely different approach. Instead of reducing uric acid production, it helps your kidneys excrete more of it. It’s best suited for people whose gout is driven by poor uric acid excretion rather than overproduction. Probenecid can be used alone if you can’t take allopurinol or febuxostat, or it can be added on top of one of those drugs if they aren’t lowering your levels enough on their own. It requires adequate kidney function to work well.
Why You May Need Both Types at Once
One of the most counterintuitive things about gout treatment is that starting a urate-lowering drug can temporarily trigger more flares, not fewer. As uric acid levels shift, crystals already deposited in your joints can loosen and provoke inflammation. This is why doctors prescribe a “bridging” anti-inflammatory alongside the new medication. Colchicine at a low daily dose or an NSAID is typically continued for three to six months after starting urate-lowering therapy to keep flares at bay during the transition.
Current guidelines also recommend starting urate-lowering therapy even during an active flare, rather than waiting for it to resolve. This was once considered risky, but evidence shows it doesn’t worsen or prolong the attack, as long as you’re also taking an anti-inflammatory.
Treatment for Severe or Refractory Gout
A small number of people don’t respond adequately to oral medications. Their uric acid stays elevated despite maximum doses, or they can’t tolerate the available drugs. For these patients, pegloticase (brand name Krystexxa) is an option. It’s an enzyme delivered by IV infusion every two weeks that directly breaks down uric acid in the bloodstream. Each infusion takes at least two hours, and patients receive antihistamines and corticosteroids beforehand to reduce the risk of allergic reactions.
Pegloticase is reserved specifically for chronic gout that has failed conventional therapy. It’s not a first, second, or even third option, but it can be life-changing for people with large tophi or frequent debilitating flares that nothing else controls.
What Makes Treatment Succeed
The single biggest predictor of long-term gout control is whether your uric acid stays below 6 mg/dL. In a structured treatment trial, 95% of patients who received consistent dose adjustments to hit that target achieved it, compared with only 30% in standard care. The group that reached target had a 67% lower risk of future flares. The medications work, but only when doses are adjusted based on regular blood tests rather than left at whatever starting dose was first prescribed.
Gout treatment also requires patience. Urate-lowering therapy is a long-term commitment, often lifelong. It can take six months to a year for flares to taper off, and existing tophi may take even longer to shrink. Many people stop their medication once they feel better, which almost guarantees the flares will return. The medicine prevents attacks by keeping uric acid low, not by curing the underlying tendency to overproduce or under-excrete it.