Many people will only ever have one attack of gout, but if you are having recurrent attacks, have tried lifestyle advice and your uric acid levels are still high, or have tophaceous gout, you may need medicines to help reduce your uric acid.

The most common medicine for this is allopurinol which is a so-called xanthine oxidase inhibitor that reduces uric acid production in the body. A newer form of medicine which works in the same way is called febuxostat. Both these drugs will reduce serum uric acid levels and both need to be taken regularly and usually for life to prevent gout attacks. These drugs can be both extremely effective and over time will gradually lead to uric acid crystals in the joints dissolving back into the blood.

When allopurinol or febuxostat are started, they can sometimes trigger an attack of gout, and so they are usually prescribed for up to 6 months with a gout preventer such as a NSAID or colchicine, which can then be stopped. Allopurinol and febuxostat usually need to be taken for life, which is why lifestyle measures are very important.

If you have an attack of gout on allopurinol or febuxostat, you should NOT stop the allopurinol as this can make long term control much more difficult. If this is the case, you should treat the acute attack and may need to increase the dose of allopurinol in the long term to prevent more attacks.

If you have had a bad reaction to allopurinol or febuxostat, there are other medicines which can help reduce uric acid but these need to be prescribed by a specialist, so ask your GP for a referral to a rheumatologist.