Medications That Can Cause Gout

Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Healthgrades Editorial Staff
Updated on August 11, 2022

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Gout, a painful form of inflammatory arthritis, is often associated with dietary choices, particularly the consumption of foods high in purines like dried beans or organ meats. These purine-rich foods contribute to an elevated level of uric acid in the bloodstream, a key factor in gout development. However, the influence of diet is just one piece of the puzzle. It's crucial to understand that certain medications, prescribed for entirely different health conditions, can also significantly impact uric acid levels and potentially trigger gout attacks.

For individuals managing gout or experiencing symptoms, understanding all potential contributing factors is vital for effective management and prevention. While dietary adjustments are a common approach, it's equally important to consider your current medication regimen. Many patients are unaware that a drug they take for one condition could be inadvertently contributing to their gout flares. If you are taking any of the medications discussed below and have experienced gout, initiating a conversation with your healthcare provider about a potential connection is a prudent step.

Diuretics (Diuril, Saluron, Thalitone)

Diuretics, commonly known as "water pills," are frequently prescribed to manage conditions such as high blood pressure and heart failure. Their primary function is to help the body eliminate excess fluid, reducing strain on the cardiovascular system. Despite their beneficial effects for these conditions, diuretics are recognized as one of the most significant pharmaceutical culprits in elevating gout risk. In fact, studies indicate that these medications can boost the likelihood of gout attacks by as much as 20%.

The mechanism behind this increased risk lies in how diuretics interact with the kidneys. While they effectively promote fluid excretion, they can simultaneously hinder the kidneys' natural ability to process and remove uric acid from the bloodstream. As the body struggles to excrete uric acid efficiently, its concentration in the blood rises, creating an environment conducive to the formation of uric acid crystals in the joints. This buildup is the direct cause of the excruciating pain and inflammation characteristic of a gout attack.

Given their widespread use and proven efficacy in treating vital conditions, diuretics are not to be discontinued without medical guidance. If you are on a diuretic and experiencing gout symptoms, your doctor can assess whether your current dosage or type of diuretic is contributing to the problem. They may consider adjusting your medication, exploring alternative treatments, or implementing additional strategies to manage your uric acid levels, all while ensuring your primary health conditions remain effectively controlled.

Aspirin

Aspirin is a widely used over-the-counter medication, prized for its analgesic (pain-relieving), anti-inflammatory, and anti-platelet properties. It might seem intuitive to reach for aspirin to alleviate the throbbing pain of a gout flare. However, this common pain reliever can paradoxically exacerbate gout symptoms or even trigger new attacks. Despite its general utility for pain, its specific interaction with uric acid metabolism makes it an unsuitable choice for gout management.

The issue with aspirin, particularly in lower doses often used for cardiovascular protection, is its ability to interfere with the kidneys' capacity to excrete uric acid. Instead of promoting its removal, aspirin can cause uric acid to be retained in the body, leading to an unwelcome accumulation. This can elevate blood uric acid levels, increasing the risk of crystal formation in the joints and, consequently, gout attacks. For this reason, healthcare providers typically advise against aspirin for gout pain.

When managing gout symptoms, a medical professional will generally recommend alternative pain relief options that do not interfere with uric acid excretion. These alternatives are specifically chosen to alleviate discomfort without worsening the underlying condition. It underscores the importance of seeking professional medical advice for gout treatment, rather than relying on self-medication, as common remedies like aspirin can have unintended adverse effects on this particular condition.

Niacin

Niacin, also known as vitamin B3, plays a crucial role in various bodily functions, and in its prescription form, it is widely utilized to help manage cholesterol levels. It can effectively lower "bad" low-density lipoprotein (LDL) cholesterol and triglycerides while raising "good" high-density lipoprotein (HDL) cholesterol, making it a valuable tool in cardiovascular health. Niacin is also available in lower doses as an ingredient in many over-the-counter dietary supplements.

However, when niacin is taken in very high quantities, specifically at doses of 3 grams or more per day, it can significantly contribute to the development or worsening of gout. The exact mechanism through which high-dose niacin affects uric acid metabolism is complex, but it is known to impede the kidneys' ability to efficiently clear uric acid from the body. This reduction in uric acid excretion leads to an increase in its concentration in the blood, raising the risk of gout attacks.

Patients prescribed high-dose niacin for cholesterol management should be made aware of this potential side effect. Similarly, individuals taking niacin supplements should be cautious about their daily intake, as exceeding recommended dosages can unwittingly contribute to this problem. Regular monitoring of uric acid levels may be necessary for those on high-dose niacin, allowing healthcare providers to balance the benefits of cholesterol management with the risk of gout.

Levodopa (Sinemet and Stalevo)

Levodopa is a cornerstone medication in the treatment of Parkinson's disease, a progressive neurological disorder affecting movement. This drug works by converting into dopamine in the brain, helping to replenish levels of this crucial neurotransmitter that are depleted in Parkinson's patients. By doing so, levodopa significantly helps to control the motor symptoms associated with the disease, such as tremors, rigidity, and slowness of movement, thereby improving the quality of life for many individuals.

While highly effective for Parkinson's symptoms, a known side effect of levodopa is its propensity to increase the level of uric acid within the body. The precise biochemical pathways involved are complex, but the elevation of uric acid is a recognized consequence of its metabolism. For patients with Parkinson's disease, who may already be predisposed to other health issues, the emergence of gout can add another layer of complexity to their medical management.

Managing Parkinson's disease often involves a delicate balance of medications to optimize symptom control while minimizing side effects. If a patient on levodopa develops gout, their healthcare team will carefully evaluate the situation. This may involve assessing the current dosage, considering other factors contributing to elevated uric acid, and determining the most appropriate course of action to manage both the Parkinson's symptoms and the gout effectively, often through collaborative efforts between neurologists and rheumatologists.

Cyclosporine (Gengraf, Neoral, Sandimmune)

Cyclosporine is a powerful immunosuppressant medication, primarily prescribed to individuals who have undergone organ transplantation, such as kidney, liver, or heart transplants. Its critical role is to suppress the body's immune system, preventing it from recognizing the transplanted organ as foreign and launching an attack that would lead to rejection. This medication is vital for the long-term success and survival of transplanted organs, allowing recipients to lead healthier lives.

Despite its life-saving benefits, cyclosporine is known to have a significant impact on uric acid metabolism. It can lead to an increase in uric acid levels in the blood, primarily by reducing the kidneys' ability to excrete uric acid effectively. This impaired excretion makes patients taking cyclosporine more susceptible to developing hyperuricemia (high uric acid levels) and, subsequently, gout. The incidence of gout in transplant patients on cyclosporine can be notably higher than in the general population.

For organ transplant recipients, the management of medication side effects, including elevated uric acid, is a critical component of their ongoing care. Their medical team continuously monitors various parameters, including uric acid levels, to proactively address potential complications like gout. Should gout develop, strategies will be implemented to manage it, often involving careful adjustments to the immunosuppression regimen or the introduction of uric acid-lowering therapies, all while ensuring the continued health of the transplanted organ.

Sources:

1. Arthritis Foundation (http://www.arthritis.org/disease-center.php?disease_id=42&df=definition);
2. US Food and Drug Administration (http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118594.htm);
3. National Institute of Arthritis and Musculoskeletal and SKin Diseases (http://www.niams.nih.gov/Health_Info/Gout/default.asp#foods);
4. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601068.html);
5. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601207.html);
6. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682878.html);
7. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/druginfo/natural/924.html);
8. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/ency/article/003476.htm);
9. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000112.htm);
10. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/tutorials/gout/id219103.pdf);
11. American College of Rheumatology (http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gout.asp);

Original article: https://resources.healthgrades.com/right-care/gout/certain-medications-can-cause-gout