Well tolerated in lower-dose regimens (eg, 0.6 mg 2–3 times daily or 1.2 mg in 1 dose and 0.6 mg 1 h later on first day, then stop11) Traditional high doses lead to considerable GI adverse effects (77%–100%)11,12; low doses shown to be much better tolerated (adverse effects 26%) and equally effective11

Avoid in patients with solid organ transplant and, if possible, in patients on dialysis. Can be used acutely in patients with reduced renal function; however, if use is prolonged (eg, beyond 10 d), reduce dose

Generally tolerated well; option if patient had previous colchicine intolerance

Following 1–3 d, can reduce dose and continue for 1–2 wk

Indomethacin is not more effective, and the potential for adverse CNS effects (eg, headache, confusion) is greater

Which NSAID has the lowest CV risk is uncertain, but current evidence suggests naproxen < ibuprofen < celecoxib.13,14 Avoid ibuprofen or separate time of adminstration if patient is taking ASA (owing to drug interaction15)

Avoid in more severe CKD (CrCl < 40 mL/min), heart failure, or history of NSAID-associated PUD

Alternative in patients with contraindications to NSAIDs or colchicine (eg, patients with history of solid organ transplant or who are taking warfarin)

Lower risk of side effects if used short-term

Short courses (ie, ≤ 1–2 wk) do not require tapering of dose

With some corticosteroids, intra-articular injection is an option if gout is monoarticular or there is a contraindication to systemic corticosteroids16

Avoid in brittle diabetic control, infection