Antigout medications are used to treat gout, a musculoskeletal disorder. Allopurinol is commonly used to prevent gout from recurring. Colchicine, classified as anti-inflammatory medication, is used to prevent and treat acute gout flares.

Allopurinol

Mechanism of Action: Allopurinol blocks the production of uric acid by inhibiting the action of xanthine oxidase.

Indications: Allopurinol is used for the prevention of gouty arthritis and for the treatment of secondary hyperuricemia.

Nursing Considerations: Allopurinol is safe for all ages. For patients with renal impairment, the dose will be reduced.

Side Effects/Adverse Effects: Adverse effects include hypotension, flushing, hypertension, drowsiness, nausea and vomiting, diarrhea, hepatitis, renal failure, drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, or drug hypersensitivity syndrome.^[1]

Patient Teaching & Education: The medication should be taken as directed. An alkaline diet may be ordered for the patient, and they may be advised to increase fluid intake to prevent kidney stone formation. The medication may cause dizziness or drowsiness. Patients who consume large amounts of alcohol may increase uric acid concentrations and decrease the effectiveness of the medication. If patients develop a rash or blood in the urine, this should be reported promptly to the health care provider.^[2]

Colchicine

Mechanism of Action: Colchicine has primarily anti-inflammatory properties.

Indications: Colchicine is indicated indicated for prophylaxis and the treatment of acute gout flares.

Nursing Considerations: The recommended dosage of colchicine depends on the patient’s age, renal function, hepatic function, and use of co-administered drugs. Colchicine is not an analgesic medication and should not be used to treat pain from other causes. It is administered orally without regard to meals.

Side Effects/Adverse Effects: The most commonly reported  side effect of colchicine is diarrhea. Life-threatening and fatal drug interactions have been reported in patients treated with colchicine given with P-gp and strong CYP3A4 inhibitors. Myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia and aplastic anemia have been reported with colchicine used in therapeutic doses. Colchicine-induced neuromuscular toxicity and rhabdomyolysis have been reported in elderly patients and those with renal dysfunction.

Patient Teaching & Education: Patients should be instructed to take colchicine as prescribed, even if they are feeling better. Patients should not alter the dose or discontinue treatment without consulting with their provider. They should report to their healthcare provider(s) all of the current medications they are taking and check before starting any new medications, particularly antibiotics, as well as nonprescription medication or herbal products. Grapefruit and grapefruit juice may also interact and should not be consumed during colchicine treatment. Patients should be informed to seek medication evaluation immediately if muscle pain or weakness, tingling or numbness in fingers or toes occur.

Now let’s take a closer look at the medication grid on antigout medication in Table 10.9.^[3]

Table 10.9 Antigout Medication Grid