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Gout

Side effects of gout medication

There are two main types of treatments for gout – medications to treat the pain and inflammation caused by an attack, and treatments to prevent attacks and long-term problems. Many people take these medications without having any side-effects.
 

Ian feels that allopurinol has been very effective for him. Gout no longer affects his everyday life.

Ian feels that allopurinol has been very effective for him. Gout no longer affects his everyday life.

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It has more than met my expectation about not getting an attack, I thought it would reduce down the level of attacks or it would help, but it's just eradicated it totally for me, so you know it's beyond my expectation really because it - it has made - it has made the situation a hell of a lot better really. I wouldn't say my life was blighted by gout in any way, shape or form, but it was really inconvenient. And it was something I could certainly do - live without. And now allopurinol has provided that for me.
Medication to treat the pain and inflammation

Some people took painkillers like paracetamol or co-codamol (paracetamol and codeine). No one we spoke to had noticed any side effects from these tablets. 
 

Eddie has tried various treatments for his attacks. He prefers to take paracetamol with codeine and ibuprofen because he did not like the side effects of other medication.

Eddie has tried various treatments for his attacks. He prefers to take paracetamol with codeine and ibuprofen because he did not like the side effects of other medication.

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I will take, paracetamol, paracetamol and codeine, colchicine, and they gave me the liquid morphine, that type of thing. But I don’t normally take much only sort of codeine and paracetamol now because the, I found the others can upset me and it upsets me more than it does any good in my mind so I don’t take it any more like that no just the paracetamol, paracetamol codeine mostly and ibuprofen, that’s what I take, yeah.

Is that ibuprofen?

Ibuprofen yeah I take that only when the gout attacks yeah, don’t take it otherwise.

And so you mentioned sort of having some side effects from some of the painkillers, you said they upset you, what kind of …?

The colchicine, when they gave it to me in hospital when I had my heart attack and I didn’t realise what it was, I knew it was a painkiller for gout because they told me, but it upset my tummy, it gave me tremendous diarrhoea and sickness, and I swore blind I would never take it again. And I have heard other people, it affects them like it, there are some who take a low dose and they find it helps but I don’t, no, and it’s like liquid morphine I had a really bad attack and I think doctor had got to the stage where you know he was giving me one of the most powerful ones he could, and I took that. It was such bad pain I think I overtook it, I’ve got to be a bit careful, and it did make me, gave me sickness, and also I was a little bit with the fairies you know, I was walking around not quite knowing where I was, yeah [laughter].
People who took non-steroidal anti-inflammatories (NSAIDs), like naproxen and diclofenac, were often aware that these could cause side effects like stomach upsets or damage the lining of the stomach. Most people had not noticed any side effects and some were taking drugs to prevent these problems (e.g. omeprazole or lansoprazole), or tablets like Arthrotec, that contain both an NSAID like diclofenac and a protective drug (e.g. misoprostol). 

Other side effects of NSAIDs include headaches, dizziness, rashes, aggravation of asthma, heart and kidney problems, and increased blood pressure. Simon would have liked more information about the possible side effects of the tablets he was prescribed. Some people had side effects when they were taking one medication so they had to change to another.
 

Simon tried several drugs that did not improve his symptoms. Indomethacin helped, but his blood pressure became high so he stopped taking it.

Simon tried several drugs that did not improve his symptoms. Indomethacin helped, but his blood pressure became high so he stopped taking it.

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I started on Voltarol and that really didn’t touch it at all. Then I was started on – I apologise, I can’t remember the name of the drug, it begins with C.

Colchicine?

That’s the one. I was put on that, that didn’t touch it either, though I remember the doctor sort of saying, “Well, this will get rid of it totally.” That made no difference whatsoever. Then I went to indomethacin, which actually seemed to give me a – more relief than the previous two, which didn’t give me relief at all. But, as I said, the side effects of that were horrendous. I really did – I remember I was then having to cope with very, very high blood pressure. My blood pressure went up to – went over sort of 240, it really shot up the blood pressure from that drug. I seemed to have every side effect that’s elicited with that drug, so I found that – though I seemed to get some relief from it, but not very much. It was – I was weighing it up – was the relief I was getting better than the side effects? And it wasn’t in the end, so I actually stopped it myself. And when I came to that conclusion, my gout seemed to have just sort of resolved itself. 

Could you talk a bit more about some of those side effects?

Well yeah, it was very – as I said, my blood pressure was very, very high. I also seemed to develop– well it’s listed on the thing - I seemed to develop a little bit like a peripheral neuropathy associated – which was quite disturbing at the time. I had some sort of tingling in my feet and my – I also couldn’t feel my feet as well as previously, which was quite disturbing at the time and I thought – I didn’t know what was going on really, because – then I started looking at the side effects of indomethacin and it listed it. I thought, “Mmm, this is interesting.” So the side effects were becoming – becoming more worrying that the gout and that’s one of the reasons I stopped taking Indomethacin.

Did you decide to stop that? 

Yes, yeah.

Was that in consultation with your GP or…?

[Sighs] probably a bit of both really. I mean I discussed it with them, because I was being – they were monitoring my blood pressure at the time and sort of trying to come to conclusions about it, but I think both of us probably felt we needed – I needed to stop. As soon as I came off it my blood pressure went back to normal, and my pins and needles went [laugh] back to normal and everything back to normal, so I’m not going to go on indomethacin again [laughs].
Colchicine is an effective drug for reducing inflammation during attacks, but it is well known for causing side effects of nausea and/or vomiting and diarrhoea when used in high doses. The risk of developing diarrhoea is reduced when lower doses are taken (e.g. one tablet every 6-8 hours) but it might take a bit longer for the medication to be effective. Doctors may prescribe an initial dose of two tablets to be followed by one tablet 3 or 4 times a day until the inflammation reduces and/or until side effects become difficult to manage, although side effects are more likely when such high doses are used. Some people we spoke to did not find the side effects too bad, but for others they were as bad or worse than the attack itself.
 

Jill takes colchicine when she has an attack, but finds the diarrhoea and sickness difficult to deal with.

Jill takes colchicine when she has an attack, but finds the diarrhoea and sickness difficult to deal with.

Age at interview: 53
Sex: Female
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I can remember coming home and getting on the sofa and making myself comfortable, and just kept popping these colchicine, and by late afternoon the unfortunate side effect of the colchicine, and it happens to most people I believe, is that you can get diarrhoea and sickness. So then you - I find myself asking the question, "Do I take the colchicine and get rid of the gout?" because it does actually get rid of the gout, or do I grin and bear the pain of the gout, and not have the side effect of the diarrhoea and sickness? So it's like you do find yourself choosing - what's it going to be, the pain or the other side effect? 
Some people had been warned about the side effects of colchicine by their doctor or pharmacist, but others had not. Val read about them in the leaflet that came with the tablets. She stopped taking colchicine before her gout symptoms had eased because she did not want the side effects to continue. Kate did not feel like eating after she took colchicine – she eventually went into hospital because she became unwell. Harry felt that putting up with the diarrhoea was ‘far better than having gout’.
 

For Alastair, the thought of an attack without medication is ‘horrendous’. Colchicine has usually improved his symptoms within six hours.

For Alastair, the thought of an attack without medication is ‘horrendous’. Colchicine has usually improved his symptoms within six hours.

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I mean I can’t imagine what it must be like to have to endure it without medication, because the medication, it works so quickly, you know. I mean it’s probably – it’s hours. I mean it works with me, I would say within a matter of five or six hours max. So, you know, now when – well, if I were to have another attack, I would just hightail it to the doctors and get the medication. The thought of enduring it without medication is horrendous, you know. I mean it’s on a par, I would suggest, with a fracture. And, you know, I’ve broken my leg and I know what that feels like, you can’t sleep. Well, it certainly prevented me from sleeping, which is like my litmus test. You know, if it’s stopping you sleeping then it’s serious, you know. 
Side effects of short courses of steroids like prednisolone are usually minimal (e.g. a minor impact on sleeping). However, long-term treatment should be used with caution because it can lead to weight gain, fluid retention, high blood pressure, diabetes and osteoporosis. Dee noticed that she put on weight while taking steroids. 
 

Paula felt like her heart was racing and she couldn’t sleep when she took steroids, but they did improve her symptoms.

Paula felt like her heart was racing and she couldn’t sleep when she took steroids, but they did improve her symptoms.

Age at interview: 46
Sex: Female
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They were prednisolone or something like that.

Did you experience side effects from taking them?

Yeah, yeah.

What kind of thing?

Sort of a – palpitations - and after I’d been on them for a few days I couldn’t sit still and I was really hyper. It was horrible. It was a really horrible feeling like my heart was just racing and I just felt really agitated and I couldn’t sleep.

How long were you supposed to take them for?

Well, they kept – they’d give me them every so often when I had a flare-up, so it was usually about five or six days. I mean the GP did one time – you know I went to see him and he did do an ECG, because he said to me that my heart was racing far more than it should’ve been. So he said to, you know, to stop them. 

So did you usually take them for the amount of time that you were prescribed them for?

I did, yeah. It was difficult because of the side effects. But then you don’t want the pain, you know, because the pain’s so bad. 

It’s difficult.

It is.

It’s a difficult decision to make. So when you were prescribed them, what did you expect them to do for you?

Well, I’d never had steroids before in my life, so I wasn’t quite sure what to expect. I mean they said that it was to manage the pain. I’d have taken anything they gave me because the pain was so bad. But I was quite impressed, because they did work very quickly for me. They took the inflammation down in my feet, in my foot, you know, within about two days the pain had gone.
Medication to prevent attacks and long-term problems

Most people we spoke to had no side effects from the daily medication they took to prevent attacks and long-term problems. Some, though, did find that starting daily medication triggered an attack. Daily NSAIDs or colchicine can be taken to suppress inflammation when first taking daily preventative treatment. It can take up to 2 years for crystals to be completely cleared from the body, so people may continue having attacks during this time. (For more see ‘Long-term treatment to lower uric acid and prevent gout attacks and long-term problems’).
 

Jonathan knew that there were rare side effects of allopurinol. He was worried about taking his first few tablets but had no problems.

Jonathan knew that there were rare side effects of allopurinol. He was worried about taking his first few tablets but had no problems.

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So the big thing, I think, was initiating the treatment, because, “Am I going to have an allergic reaction?” Okay, people have got to warn you of that even though it’s quite, it’s quite rare. So, actually, “Am I going to have a reaction?”

So, I can remember we, we actually, I was away with my partner at Christmas. We went to stay in a B&B in the Lakes, and I was going to start allopurinol. So I had my 50-milligram tab, and it was probably quite, quite a big thing [Laughter]. So this is the first time you’re going to take something that you’re probably going to take for the rest of your life. So, I had that, nothing happened, and then over the next few – so I went up to 100 milligrams, and I think it was that for a couple of weeks, and then 200 milligrams, then 300 milligrams.
Serious side effects from allopurinol are rare – the majority of people do not have any problems but the most common side effect is a skin rash. This is not serious but may mean people have to stop taking the tablets. Harry had a reaction to allopurinol. His skin became red and then peeled off like sunburn. His GP told him to stop taking the tablets and he now takes febuxostat as a daily preventative medication. Some people noticed other symptoms and were not sure if they were caused by their medication or not. Sam noticed that she felt thirstier since taking allopurinol. 
 

Allopurinol made John’s skin itchy and tingly. A specialist prescribed a very low dose and then increased it. He’s had no problems since.

Allopurinol made John’s skin itchy and tingly. A specialist prescribed a very low dose and then increased it. He’s had no problems since.

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Allopurinol used to make me, sort of tingle, and itch, and so, I couldn’t take it. 

Anyway, they tried me on a couple of things, and what they said they’d do they’d start off with a tiny, tiny 0.5 I think it was, allopurinol again, and build it up, which they did do. And, I’m on it, and I’ve no great problems with it now. And, so, that has sort of brought my reading down, from something like 12, or more sometimes, down to three, two or three. And he, he said he didn’t want me seeing him again, I think it was September last year, or somewhere around that time, you know, unless I had any problems. He didn’t want to see me again. So, that’s me, although he’s a nice chap, you know I was quite happy.
The most serious side effect is called ‘allopurinol hypersensitivity syndrome’, which also involves skin reactions as well as liver and kidney problems. Fortunately this is rare and only affects one in a thousand people treated with allopurinol [Zineh, Mummaneni, Lyndly, Amur, La Grenade, Chang, Rogers, and Pacanowski, 2011]. If people have any side effects from allopurinol such as a rash, nausea, headaches or indigestion, they should stop taking the tablets and ask their doctor for advice. Lower doses, and more caution when increasing doses, are needed for people who have kidney problems because they are at more risk of side effects. Gerald’s specialist changed his medication from allopurinol to febuxostat because of concerns about his liver and kidney function. Allopurinol can also affect some other tablets like warfarin and azathioprine, so people must tell their doctor if they are taking these drugs.
 

Peter leads an active life and is not affected by gout. He’s had no problems with allopurinol.

Peter leads an active life and is not affected by gout. He’s had no problems with allopurinol.

Age at interview: 75
Sex: Male
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It was a shock when the doctor told me I was, “How long have you had gout?”, and I said, “I haven’t”, but no, no problem. You take the tablets, so when I got the tablets right, and knew I had to take one every day there’s no problem. I’ve had no problem with gout, I carry on and as you see outside I’ve got a large garden, I’ve got a log burner so I do a lot of sawing, I am physically fit, I’ve always been a physical person. So yes, I’ve never had my uric acid level test, checked lately, but I do go, we do have a review every six months at our doctors so I’m sure they check it all out.
Some people were worried about taking daily medication because of concerns about side effects. (For more see ‘Thoughts about the future and long-term effects’). Vic started taking daily allopurinol after about ten years of painful attacks. He’d initially misunderstood what he was told and thought that it was likely to cause major side effects. He then found out that side effects were rare, and wished he’d known more at the start. Harry believes that if people were more aware of the long-term risks of not taking daily medication (e.g. joint damage and kidney problems) they would be more willing to try medication.
 

Pat was concerned at first about possible side effects. She has been taking allopurinol for four years and has had no problems.

Pat was concerned at first about possible side effects. She has been taking allopurinol for four years and has had no problems.

Age at interview: 61
Sex: Female
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So when you first went along, and had the diagnosis and everything, how did you feel about starting on a long term medication?

I was a bit concerned, and obviously I did look it up and read all the side effects and things. But then I felt – I took it and I didn’t have any problems with it or any side effects, so I felt that it would probably be all right. And if I have to stay on it, I have to stay on it

What were you main concerns, when you said that you were concerned about the idea?

Well, whether there were any side effects, or whether there’s any long term problems related to taking the drug for a long period of time. I don’t appear to have had any side effects or long term problems, and I’ve now been on it four, five years. It’s four years now, yeah. 



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Last reviewed December 2016
Last updated December 2016
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