There are many urate-lowering therapies, with more in development. You need to choose the right one, and you might need pain relief for the weeks or months it takes to lower uric acid to a safe level.
Whichever gout cure you choose, make sure it keeps your uric acid at 5 mg/dL (0.30 mmol/L), or below.
In this part of the Gout Treatment Guidelines, I explain medicines that reduce uric acid. Other pages look at pain relief, but the only way you can avoid gout pain completely is to get rid of the excess uric acid that causes it.
Most medics label these treatments as ULTs – Urate Lowering Therapies, and they fall into one of three groups:
Help you excrete excess uric acid
Reduce the amount of uric acid you produce
Convert excess uric acid into harmless byproducts
Uricosurics are useful if your 24-hour urine test shows that you are an under-excreter. The other 2 groups are suitable for both under-excreters and over-producers. Converters are quite new, and not widely available yet.
One final point about avoiding gout before we look at specific medicines. Currently, most doctors will not prescribe urate-lowering therapy until you have had 2 or 3 gout attacks. This means that you have a few months, possibly years, of uric acid crystals lodged in your joints and body tissues. Therefore, it pays to manage uric acid reduction in two phases. Firstly, you set your target uric acid at around 2 or 3mg/dL (under 0.20 mmol/L) until old uric acid crystals are dissolved. Then you adjust the dosage to maintain uric acid level of around 5mg/dL (0.30 mmol/L). There is more information about this in the Understanding Gout Section.
Uric Acid Blockers
Xanthine Oxidase Inhibitors (XOIs) help to avoid gout. By blocking the enzyme that allows your body to produce uric acid.
Not commonly used. No longer manufactured in United States, though FDA drug records indicate that “product was not discontinued or withdrawn for safety or efficacy reasons”.
Uric Acid Transformers
Uric acid converters help to avoid gout. By breaking down uric acid into a harmless compound.
Humans do not possess the uricase enzyme that converts uric acid to allantoin. A genetically modified form of uricase called rasburicase has been produced to try to provide this, but it has severe risks and restrictions. It is currently only available in the US for cancer patients with high uric acid levels from chemotherapy.
Urate oxidase treatments that are chemically modified with PEG (PolyEthylene Glycol) to try to reduce the risks are under development.
Medical Disclaimer: The pupose of GoutPal is to provide jargon-free explanations of medical gout-related terms and procedures. Because gout sufferers need to know what questions to ask their doctor. Also, you need to understand what your doctor tells you. So this website explains gout science. But it is definitely NOT a substitute for medical advice.
Information on this website is provided by a fellow gout sufferer (Keith Taylor) with an accountant's precision for accurate data. But no medical qualifications. So you must seek professional medical advice about gout and any other health matters.