Action
Administer
- NSAIDs (Class I): × 24 hr post symptom relief, with quick taper; +/- colchicine
- Indomethacin 50 mg PO tid, or
- Naproxen 500 mg PO bid, or
- Ibuprofen 800 mg PO tid
Also
- Discontinue diuretics when able (Class II)
- Provide alcohol and dietary counseling
- Follow up with rheumatology
Background
NSAIDs
“The first-line therapy for this disease is oral NSAID treatment; in particular, indomethacin 50 mg orally 3 times per day is recommended, although there are no trials showing indomethacin is more effective in providing pain relief than other NSAIDs”
Colchicine
“To avert the highlighted risks or side effects of NSAID use, oral colchicine is an alternative. Colchicine inhibits microtubule formation and the inflammatory reaction to crystal presence, and may be used when NSAID administration is not appropriate. Caution should be used for patients with renal or hepatic insufficiency, and dose adjustments may be necessary. The use of colchicine with concurrent CYP3A4 inhibitors in the setting of renal or hepatic insufficiency is contraindicated. The parenteral form of colchicine has the potential for severe toxicity and should be avoided; it is not available in the United States or Canada.60 Low-dose regimens (eg, 1.2 mg orally followed by 0.6 mg orally 1 hour later) have fewer side effects than high-dose regimens and have been standard for more than 10 years.”
