Indomethacin is the most commonly prescribed anti-inflammatory treatment for gout.
Until recently, “3 Indocin a day” has been a valid alternative to proper control of uric acid.
No longer.
Rheumatologists have made it clear that the best approach is Treat To Target, and target is safe uric acid levels, set on an individual case basis, and usually 5mg/dL. There are lots of other discussions about safe uric acid levels, and I do not want to get side-tracked with that issue. Here we focus on indomethacin.
Indomethacin Gout Treatment
The indomethacin dosage for gout guidelines are to take 50mg three times per day. No mention is made with respect to the maximum dose of 200mg per day for gout, but this is something you might discuss with your doctor. If sleeping with a gout flare is difficult, what is your doctor’s response to doubling the third dose? Please share your experiences below if you have discussed this with your doctor.
Indomethacin Gout Guidelines
There are no specific guidelines yet for exactly how indomethacin should be used in gout treatment. Publishing of guidelines is a long process, and always ends with the rider that individual cases are more important than guidelines. We should not expect specific guidelines – we should develop our own personal indomethacin gout treatment plan.
Immediately after diagnosis, there is always the question of whether to treat gout immediately, or wait to see if lifestyle changes will be enough. Unfortunately, this is rarely a proper plan, and leaving it vague means that the gout patient loses confidence in the doctor, and just keeps popping the Indocin during an attack.
If you are going to wait for allopurinol, or other uric acid lowering treatment, at least have a six month cut-off. Rely on indomethacin as required for six months whilst you try to make diet changes to get uric acid to 5 or below. After six months, if uric acid is still not safe, start allopurinol, backed up with colchicine and indomethacin.
If gout has been left untreated for a long time, you should aim much lower that 5 for at least six months. This gives you sufficient time to get gout under control, without risking indomethacin for too long.
Though there are no official guidelines, my indomethacin & gout guidelines will help you form a good plan with your doctor.
Be prepared to argue your case, as this new thinking will take time to spread. It is no longer acceptable to take indomethacin for several months without a uric acid lowering plan.
It is no longer acceptable to continue indomethacin for several months whilst on uric acid lowering treatment – the treatment should be monitored and controlled so that uric acid levels are low enough to remove the need for indomethacin.
Do you have a clear indomethacin gout treatment plan?