88 Acute Gout Attack
BUY
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-Naproxen sodium (Anaprox, Anaprox-DS) 550 mg PO bid OR
-Methylprednisolone (SoluMedrol) 125 mg IV x 1 dose THEN
-Prednisone 60 mg PO qd for 5 days, followed by tapering.
-Colchicine 2 tablets (0.5 mg or 0.6 mg), followed by 1 tablet q1h until relief,
max dose of 9.6 mg/24h. Maintenance colchicine: 0.5-0.6 mg PO qd-bid.
Hypouricemic Therapy:
-Probenecid (Benemid), 250 mg bid. Increase the dosage to 500 mg bid
after 1 week, then increase by 500-mg increments every 4 weeks until the
uric acid level is below 6.5 mg/dL. Max dose 2 g/d. Contraindicated during
acute attack.
-Allopurinol (Zyloprim) 300 mg PO qd, may increase by 100-300 mg q2weeks.
Usually initiated after the acute attack.
9. Symptomatic Medications:
-Ranitidine (Zantac) 150 mg PO bid.
-Meperidine (Demerol) 50-100 mg IM/IV q4-6h prn pain OR
-Hydrocodone/acetaminophen (Vicodin), 1-2 tab q4-6h PO prn pain
10. Labs: CBC, SMA 7, uric acid. UA with micro. Synovial fluid for light and
polarizing micrography for crystals; C&S, Gram stain, glucose, protein, cell count.
X-ray views of joint. 24 hour urine for uric acid.