Gout Drug Summary

Last updated: 19 September 2025
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Corticosteroids - Intra-articular

Drug Dosage Remarks
Betamethasone Small joints: 0.25-0.5 mL intra-articular
Medium joints: 0.5-1 mL intra-articular
Large-very large joints: 1-2 mL intra-articular		 Adverse Reactions
  • Local effects (post-injection flare, thrombophlebitis, sterile abscess)
Special Instructions
  • Systemic absorption should always be considered
  • Use with caution in patients with pre-existing psychiatric conditions, heart failure, DM, GI diseases, hepatic impairment including cirrhosis, myasthenia gravis, cataracts and/or glaucoma, osteoporosis, renal impairment, history of seizure disorder, thyroid disease, acute MI
Dexamethasone 0.2-6 mg intra-articular as a single dose
May repeat from once every 3-5 days to once every 2-3 weeks
Methylprednisolone Small joints: 4-10 mg/dose intra-articular
Medium joints: 10-40 mg/dose intra-articular
Large joints: 20-80 mg/dose intra-articular
Triamcinolone Small joints: 2.5-5 mg intra-articular
Large joints: 5-15 mg intra-articular
Max dose: 20-80 mg/treatment

Corticosteroids - Systemic

Drug Dosage Remarks
Betamethasone 0.5-5 mg/day PO in divided doses or
0.25-9 mg IM 24 hourly 		Adverse Reactions
  • CNS effects (depression, insomnia, nervousness); GI effects (GI upset, increased appetite, indigestion); Other effects (edema, increased susceptibility to infection, muscle wasting, weakness, Cushing-like features)
  • Adverse effects are associated with long-term use
Special Instructions
  • Use with caution in patients with pre-existing psychiatric conditions, heart failure, DM, GI diseases, hepatic impairment including cirrhosis, myasthenia gravis, cataracts and/or glaucoma, osteoporosis, renal impairment, history of seizure disorder, thyroid disease, acute MI
Cortisone 25-150 mg IV/IM 24 hourly
Dexamethasone 0.75 mg PO 6-12 hourly or
0.5-9 mg or 0.05-0.2 mg/kg IV/IM 24 hourly
Hydrocortisone 20-240 mg/day PO in 2 to 4 divided doses or
100-500 mg IV/IM
May repeat doses at 2-, 4-, or 6-hour intervals
Methylprednisolone 4-48 mg/day PO in single or divided doses or
10-40 mg IV/IM, may repeat 4-6 hourly for 48 hours or
10-80 mg IM 24 hourly
Prednisolone Initial dose: 5 mg PO 24 hourly
Max dose: 60 mg PO 24 hourly
Triamcinolone 4-48 mg PO 24 hourly

Hyperuricemia & Gout Preparations

Drug Dosage Remarks
Preparations Increasing Uric Acid Excretion
Benzbromarone1 Initial dose: 25-50 mg PO
24 hourly
Maintenance dose: 50 mg PO
8-24 hourly or 100 mg PO 24 hourly 		Adverse Reactions
  • GI effects (GI disturbances, diarrhea); Other effects (hypersensitivity reaction, hepatotoxicity, acute gout attacks)
Special Instructions
  • Contraindicated in moderate and severe renal dysfunction, in patients with uric acid renal calculi and those with renal urate excretion >700 mg/24 hour
Dotinurad Initial dose: 0.5 mg PO 24 hourly
Maintenance dose: 2 mg PO 24 hourly
Max dose: 4 mg/day 		Adverse Reactions
  • Musculoskeletal effects (gouty arthritis, arthritis, limb discomfort, arthralgia); GI effects (soft feces, diarrhea, nausea); Other effects (malaise, rash, nephrolithiasis, nephrocalcinosis)
Special Instructions
  • Not to be administered in patients with oliguria or anuria
  • Not to be started in patients with gouty arthritis (gout attack) until symptoms have disappeared
Probenecid 250 mg PO 12 hourly for 1 week,
followed by 500 mg PO 12 hourly
thereafter
May increase by 500-mg increments every 4 weeks
Max dose: 2 g/day 		Adverse Reactions
  • CNS effects (seizure, headache, anorexia, dizziness); GI effects (nausea/vomiting, sore gums, GI disturbances, diarrhea); Other effects (dermatitis, nephrolithiasis, pruritus)
  • Potentially fatal effects (hepatic necrosis, aplastic anemia, anaphylaxis)
Special Instructions
  • Contraindicated in severe renal dysfunction, patients with acute gout, blood dyscrasias and uric acid nephrolithiasis
Sulfinpyrazone
(Sulphinpyrazone)		 Initial dose: 100-200 mg PO 12 hourly
May increase gradually to 600 mg PO 24 hourly over 1-3 weeks
Maintenance dose:
200 mg PO 12 hourly
Max dose: 800 mg/day 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, jaundice, hepatitis); Other effects (rashes, salt and water retention, blood dyscrasias, acute gout attack, renal impairment or failure)
Special Instructions
  • Contraindicated in patients with uric acid renal calculi, active peptic ulcer, blood dyscrasias, severe kidney or liver impairment
  • Ensure adequate fluid intake to prevent development of uric acid renal calculi
Preparations Inhibiting Uric Acid Production
Allopurinol Initial dose: 100 mg PO 24 hourly
Mild: 100-200 mg/day
Moderately severe: 300-600 mg/day
Severe: Up to 900 mg/day
Max dose: 900 mg/day
Any single oral dose should not be
>300 mg PO; doses >300 mg/day
should be given in divided doses 		Adverse Reactions
  • Dermatologic effects (exfoliative rash, Stevens Johnson syndrome, toxic epidermal necrolysis); Hematologic effects (leukopenia, leukocytosis, eosinophilia)
Special Instructions
  • Not to be used for asymptomatic hyperuricemia
  • Use with caution in patients with severe renal and hepatic impairment
Febuxostat Initial dose: 40-80 mg PO 24 hourly
May be increased up to 120 mg PO
24 hourly as needed
Gout flare prophylaxis for at least 6 months with an NSAID or Colchicine is recommended at treatment initiation 		Adverse Reactions
  • GI effects (diarrhea, nausea, liver function abnormalities); Other effects (rash, headache)
Special Instructions
  • Use with caution in patients with hepatic and severe renal impairment, major CV disease
Preparation Metabolizing Uric Acid
Pegloticase 8 mg IV infusion every 2 weeks Adverse Reactions
  • Dermatologic effects (dermatitis, pruritus, irritation, dryness); Other effects (gout flare, infusion-related reactions, joint swelling, hyperglycemia, influenza-like illness)
Special Instructions
  • Not to be given as an IV push or bolus
  • Contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, asymptomatic hyperuricemia
Preparation with No Effect on Uric Acid Metabolism
Colchicine Initial dose: 1 mg PO followed by
0.5 mg PO 2-3 hourly until pain relief is obtained
Max dose: 6 mg/course
Another course may be given after 3 days
Prophylaxis: 0.5 mg PO 8-12 hourly
or
Initial dose: 1.2 mg PO followed by
0.6 mg PO after 1 hour or 0.6-1.2 mg PO 2 hourly until pain relief is obtained
Max dose: 1.8 mg over a 1-hour period
Another course may be given after 3 days
Prophylaxis: 0.6 mg PO 12-24 hourly 		Adverse Reaction
  • GI effects (diarrhea, abdominal cramps, nausea/vomiting); Other rare effects (bone marrow suppression, myopathy, neuropathy)
Special Instructions
  • A low-dose regimen of 1.5-1.8 mg/day is preferred over a high-dose regimen (4.5-4.8 mg/day) for pain reduction in patients with acute gouty arthritis
  • Use with caution in patients with mild to moderate renal and hepatic impairment; adjust dose according to individual safety and tolerability
  • Contraindicated in patients with blood dyscrasia and severe renal/hepatic impairment; patients on hemodialysis; concomitant use with P-glycoprotein inhibitors or strong CYP3A4 inhibitors in patients with renal or hepatic impairment
 1Combination with Allopurinol is available. Please see the latest MIMS for specific formulations and prescribing information.

Immunosuppressants

Drug Dosage Remarks
Interleukin (IL) Inhibitor
Canakinumab 150 mg SC single dose during an
attack		 Adverse Reactions
  • Respiratory effects (nasopharyngitis, pneumonia, sinusitis, pharyngitis, tonsillitis, bronchitis); CNS effects (dizziness, vertigo); GI effects (gastroenteritis, upper abdominal pain); Musculoskeletal effects (back pain, fatigue); Hematologic effects (leukopenia, neutropenia); GU effects (UTI, proteinuria, decreased creatinine renal clearance); Other effects (viral infection, cellulitis, ear infection)
Special Instructions
  • Use with caution in patients with serious infections, neutropenia, leukopenia, hepatic/renal impairment, immunosuppression
  • Avoid concomitant use with live vaccines and tumor necrosis factor (TNF) inhibitors
  • Perform TB screening test prior to initiation of treatment
  • Contraindicated in patients with active severe infection

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Drug Dosage Remarks
Acetic Acid Derivatives
Acemetacin 90 mg PO 12-24 hourly x 5 days Adverse Reactions
  • GI effects (nausea, GI discomfort, diarrhea, peptic ulceration, GI bleeding); CNS effects (headache, vertigo, dizziness, nervousness, tinnitus, depression, drowsiness, insomnia); Hypersensitivity reactions (angioedema, bronchospasm, rashes, Stevens-Johnson syndrome occur rarely); Hematologic effects (anemia, thrombocytopenia, neutropenia); Other effects (hepatotoxicity, nephrotoxicity, hematuria, fluid retention, photosensitivity, pancreatitis)
Special Instructions
  • Give with food to decrease GI effects
  • Avoid use in patients with active peptic ulceration, severe heart failure, history of allergy to NSAIDs
  • Use with caution in patients with hypertension, infections, asthma or allergic conditions, hemorrhagic disorders, hepatic or renal impairment

 
 
   
  
Diclofenac1 75-150 mg/day PO in divided doses or 100 mg PO 24 hourly or 75 mg intragluteal injection 12-24 hourly x 2 days
Max dose: 150 mg/day
Indometacin (Indomethacin)2 50 mg PO 6-8 hourly
Reduce dose or stop intake once pain subsides
Proglumetacin Initial dose: 450-600 mg/day PO in divided doses
May increase up to 900 mg/day PO divided 8 hourly
Maintenance dose: 300-450 mg/day PO divided 12 hourly
Sulindac 150-200 mg PO 12 hourly
Max dose: 400 mg/day
Butylpyrazolidine
Phenylbutazone Initial dose: 600-800 mg/day PO divided 8-12 hourly
Maintenance dose: 100 mg PO 4 hourly
Coxib
Etoricoxib 120 mg PO 24 hourly
Max duration: 8 days
Oxicam Derivatives
Meloxicam 15 mg PO 24 hourly
May reduce to 7.5 mg/day
Piroxicam 40 mg PO 24 hourly as a single dose followed by 40 mg PO 24 hourly as a single or divided doses on the next 4-6 days
Tenoxicam 40 mg PO 24 hourly x 2 days then 20 mg PO 24 hourly x 5 days
Propionic Acid Derivatives
Dexketoprofen 12.5 mg PO 4-6 hourly or 25 mg PO 8 hourly
Max dose: 75 mg/day
Fenbufen 300 mg PO in the morning and 600 mg PO at bedtime
Ibuprofen 200-400 mg PO 6-8 hourly
Max dose: 2.4 g/day
Ketoprofen 50 mg PO 6-8 hourly or 100 mg PO 8-12 hourly or
200 mg PO 24 hourly
Naproxen Initial dose: 750 mg PO followed by
Maintenance dose: 250 mg PO 8 hourly or
Initial dose: 825 mg PO followed by
Maintenance dose: 275 mg PO 8 hourly or
Initial dose: 1,000-1,500 mg PO followed by
Maintenance dose: 1,000 mg PO 24 hourly
1Diclofenac Na and Lidocaine HCl injection combination is available. Please see the latest MIMS for specific formulations and prescribing information.
2Combination with Methocarbamol is available. Please see the latest MIMS for specific formulations and prescribing information.

Other Drugs Acting on the Genito-urinary System

Drug Dosage Remarks
Citric acid/Sodium citrate1 Citric acid 334 mg/Sodium citrate 500 mg/5 mL
Initial dose: 10-30 mL oral solution 6 hourly, diluted in 30-90 mL of water 		Adverse Reaction
  • CNS effects (dizziness, muscle twitching, mood or mental changes, restlessness, seizures); CV effects (increased heart rate, high BP); Other effects (swelling of feet or lower legs, weakness, unusually slow breathing, hypernatremia, metabolic alkalosis)
Special Instructions
  • Take after meals
  • Use with caution in patients with renal disorders
  • Monitor urinary citrate and pH, rise in serum K, creatinine or fall in hematocrit or Hb values, ECG in patients with cardiac disease
  • Contraindicated in heart failure, severe renal impairment, peripheral or pulmonary edema, hypertension; patients on a Na-restricted diet
Potassium citrate1 30 mEq PO 24 hourly in 3 divided doses
Adjust dose to maintain urine pH at 6.2-6.8
Max dose: 100 mEq/day 		Adverse Reaction
  • Slight GI disorders
Special Instructions
  • Take 30 minutes after meals; do not chew
  • Contraindicated in renal insufficiency, persistent alkaline UTI, obstruction of urinary tract, hyperpotassemia, adrenal insufficiency
1Combination preparations are available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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