chronic

Gout

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 sources

ULORIC (febuxostat) tablets US prescribing information, section 2.1 Recommended Dosage (DailyMed SetID 54de10ef-fe5f-4930-b91d-6bbb04c664bd): "The recommended starting dosage of ULORIC is 40 mg once daily. For patients who do not achieve a serum uric acid (sUA) less than 6 mg/dL after two weeks, the recommended ULORIC dosage is 80 mg once daily." The 120 mg ceiling is from ADENURIC 120 mg film-coated tablets SmPC section 4.2 (eMC product 1925): "If serum uric acid is > 6 mg/dL ... after 2-4 weeks, ADENURIC 120 mg once daily may be considered." The US label's own ceiling is 80 mg daily. · ACR Management of Gout 2020 for the treat-to-target strategy, with the dose from Allopurinol tablets US prescribing information, section 2.3 Recommended Dosage for Gout (DailyMed SetID 211e47c6-85b9-43e8-9e07-6cc4b8f708a0): "Patients with normal kidney function: Initial dosage is 100 mg orally daily. Increase by 100 mg weekly increments until serum uric acid of 6 mg/dl or less is reached (maximum 800 mg daily)." The label's titration step is weekly against the monthly step given here. · ACR Management of Gout 2020 for the treatment strategy, with the acute regimen from Colchicine 500 microgram tablets SmPC section 4.2 (eMC product 100968): "Treatment of acute gout attack: 1 mg (2 tablets) to start followed by 500 micrograms (1 tablet)" an hour later, then "No further tablets should be taken for 12 hours." The SmPC allows the course to resume after that, ending "when symptoms are relieved or when a total of 6 mg (12 tablets) has been taken", above the 1.5 mg per course given here. · ACR Management of Gout 2020 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)

Verified against8 documents

ULORIC (febuxostat) tablets US prescribing information, section 2.1 Recommended Dosage (DailyMed SetID 54de10ef-fe5f-4930-b91d-6bbb04c664bd): "The recommended starting dosage of ULORIC is 40 mg once daily. For patients who do not achieve a serum uric acid (sUA) less than 6 mg/dL after two weeks, the recommended ULORIC dosage is 80 mg once daily." The 120 mg ceiling is from ADENURIC 120 mg film-coated tablets SmPC section 4.2 (eMC product 1925): "If serum uric acid is > 6 mg/dL ... after 2-4 weeks, ADENURIC 120 mg once daily may be considered." The US label's own ceiling is 80 mg daily.
ACR Management of Gout 2020 for the treat-to-target strategy, with the dose from Allopurinol tablets US prescribing information, section 2.3 Recommended Dosage for Gout (DailyMed SetID 211e47c6-85b9-43e8-9e07-6cc4b8f708a0): "Patients with normal kidney function: Initial dosage is 100 mg orally daily. Increase by 100 mg weekly increments until serum uric acid of 6 mg/dl or less is reached (maximum 800 mg daily)." The label's titration step is weekly against the monthly step given here.
ACR Management of Gout 2020 for the treatment strategy, with the acute regimen from Colchicine 500 microgram tablets SmPC section 4.2 (eMC product 100968): "Treatment of acute gout attack: 1 mg (2 tablets) to start followed by 500 micrograms (1 tablet)" an hour later, then "No further tablets should be taken for 12 hours." The SmPC allows the course to resume after that, ending "when symptoms are relieved or when a total of 6 mg (12 tablets) has been taken", above the 1.5 mg per course given here.
ACR Management of Gout 2020
Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)
Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)
Gout - disease-level clinical article (gout-clinical.txt)
Egyptian National Drug Formulary (endf-endocrine.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

An acute flare starts abruptly with severe pain, redness, and swelling that peaks within 12 to 24 hours, almost always in one joint [redness]
The big toe joint is involved in about half of first attacks, and nearly 90% of patients eventually develop it there
Flares are commonly triggered by trauma, alcohol binges, fasting or overeating, weight changes, diuretics, or starting urate-lowering therapy [overeating]
Flares tend to strike at night or in the early morning, often waking the patient from sleep
About 60% of patients have a second attack within a year, and 80% within three years
Tophi typically take ten years or more to develop after the first gout attack, though microtophi may form earlier

Signs — what you find (4)

The joint is warm, red, and swollen and is extremely tender to touch; more than four joints involved is termed polyarticular gout
Inflammation can extend beyond the joint, resembling cellulitis with redness and skin peeling [cellulitis · redness]
Tophi cluster mainly around the ears, finger pads, tendons, bursae, and joints
Finger pad tophi occur in about 30% of chronic tophaceous gout and may appear before an attack in postmenopausal women with kidney disease

Tests (6)

Finding needle-shaped urate crystals in joint fluid under polarized light microscopy is the gold-standard test
In septic arthritis the joint fluid white cell count typically runs over 50,000 per microliter, mostly neutrophils
The best time to check baseline serum urate is two weeks or more after a flare has settled
A uric acid level above 6.8 mg/dL supports the diagnosis but is not required or sufficient on its own
X-rays of an affected joint can show punched-out, rat-bite-type erosions with thin overhanging edges
Ultrasound's double-contour sign is about 83% sensitive and 76% specific, while dual-energy CT is about 87% sensitive and 84% specific

If not this — what else fits (4)

Septic arthritis shows a positive synovial gram stain and culture with low synovial glucose, and can coexist with gout
Rheumatoid arthritis enters the differential for tophaceous gout mainly when rheumatoid nodules are present
Pseudogout, caused by calcium pyrophosphate crystals rather than urate, is distinguished by joint fluid analysis
Osteoarthritis and psoriatic arthritis are both on the differential for an acute gout flare

SourceStatPearls "Gout" - disease-level clinical article

Presentation findings are traced to the source above.

COLCHICINE

1st line

Strength0.5 mg

Formoral.solid

Adult dose and duration

1 mg initially, then 0.5 mg 1h later (max 1.5 mg per course) x 3 days

Paediatric dose

Specialist use only in children

Dose source

ACR Management of Gout 2020 for the treatment strategy, with the acute regimen from Colchicine 500 microgram tablets SmPC section 4.2 (eMC product 100968): "Treatment of acute gout attack: 1 mg (2 tablets) to start followed by 500 micrograms (1 tablet)" an hour later, then "No further tablets should be taken for 12 hours." The SmPC allows the course to resume after that, ending "when symptoms are relieved or when a total of 6 mg (12 tablets) has been taken", above the 1.5 mg per course given here.

Why

Anti-inflammatory that inhibits neutrophil migration and activation by disrupting microtubule assembly, used for rapid control of an acute gout flare; its narrow therapeutic index means the recommended course must not be exceeded.

Cautions

Diarrhoea or vomiting signals toxicity - stop immediately.
Reduce dose in renal impairment; avoid with strong CYP3A4 inhibitors.
Colchicine has a narrow therapeutic index, so do not exceed the recommended dose.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
COLCHICINE 500 MCG 100 TABS.	EL NASR	190.00 EGP (1.90/unit)
COLMEDITEN 0.5 MG 100 TABS.	KAHIRA	190.00 EGP (1.90/unit)
GOURYST 0.5 MG 100 TABS.	PHAROPHARMA	190.00 EGP (1.90/unit)

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400-800 mg TID with food for acute gout flare x 5-7 days

Paediatric dose

Specialist use only for pediatric arthritis

Choice

Alternatives. An NSAID, colchicine and a steroid are co-equal for an acute gout flare; ibuprofen costs 4-78 EGP against colchicine's 190, and colchicine's dosing is easy to get wrong.

Dose source

Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)

Why

NSAID that reduces the inflammatory response of an acute gout flare through cyclo-oxygenase inhibition; an alternative to colchicine for patients without contraindications such as peptic ulcer disease or significant renal impairment.

Cautions

Avoid in peptic ulcer disease, severe heart failure, or CKD.
Take with meals or gastroprotection.
Discontinue when acute flare resolves.
Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus).
Above 1200 mg a day is prescription territory, not the over-the-counter suspension. The tablet label allows up to 2400 mg in three or four divided doses, but only as a temporary increase in an acute severe episode, and no single dose above 800 mg.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DAJUANOFEN 400 MG 20 F.C. TABS.	COPAD PHARMA	5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.	DELTA PHARMA	3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETS	SANOFI	12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.	SEDICO	6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABS	EIPICO	42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.	KAHIRA > ABBOTT LABORATORIES	78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.	EUROPEAN EGYPTIAN PHARM. IND.	31.00 EGP
ANALGIPROF 400 MG 25 SACHETS	EVA PHARMA	37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	SANOFI	2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	4.50 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Gout - disease-level clinical article (gout-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - The criteria for rheumatology referral are unclear etiology, renal impairment limiting drug choice, inadequate response to a xanthine oxidase inhibitor, multiple intolerances, and refractory or tophaceous gout.
RED FLAG - Septic arthritis needs to be excluded (arthrocentesis or synovial fluid analysis) before presumptively treating an unclear acute flare, since oral or intra-articular glucocorticoids can worsen undiagnosed septic arthritis.

PREDNISOLONE

1st line

Strength5 mg

Formoral.solid

Adult dose and duration

5 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses. x 5 to 10 days

Paediatric dose

0.1-2 mg/kg/day

(Children: 0.1 to 2 mg/kg/day orally in 1 to 4 divided doses.)

Dose by weight
3kg	0.3-6 mg/day
4kg	0.4-8 mg/day
5kg	0.5-10 mg/day
6kg	0.6-12 mg/day
7kg	0.7-14 mg/day
8kg	0.8-16 mg/day
9kg	0.9-18 mg/day
10kg	1-20 mg/day
11kg	1.1-22 mg/day
12kg	1.2-24 mg/day
13kg	1.3-26 mg/day
14kg	1.4-28 mg/day
15kg	1.5-30 mg/day
16kg	1.6-32 mg/day
17kg	1.7-34 mg/day
18kg	1.8-36 mg/day
19kg	1.9-38 mg/day
20kg	2-40 mg/day
21kg	2.1-42 mg/day
22kg	2.2-44 mg/day
23kg	2.3-46 mg/day
24kg	2.4-48 mg/day
25kg	2.5-50 mg/day
26kg	2.6-52 mg/day
27kg	2.7-54 mg/day
28kg	2.8-56 mg/day
29kg	2.9-58 mg/day
30kg	3-60 mg/day
31kg	3.1-62 mg/day
32kg	3.2-64 mg/day
33kg	3.3-66 mg/day
34kg	3.4-68 mg/day
35kg	3.5-70 mg/day
36kg	3.6-72 mg/day
37kg	3.7-74 mg/day
38kg	3.8-76 mg/day
39kg	3.9-78 mg/day
40kg	4-80 mg/day
41kg	4.1-82 mg/day
42kg	4.2-84 mg/day
43kg	4.3-86 mg/day
44kg	4.4-88 mg/day
45kg	4.5-90 mg/day
46kg	4.6-92 mg/day
47kg	4.7-94 mg/day
48kg	4.8-96 mg/day
49kg	4.9-98 mg/day
50kg	5-100 mg/day

Dose source

Egyptian National Drug Formulary (endf-endocrine.txt)

Why

Systemic glucocorticoid used as first-line anti-inflammatory treatment for acute gout flares, particularly when NSAIDs or colchicine are contraindicated.

Cautions

Use with caution in patients with diabetes mellitus, hypertension, osteoporosis, or active infection.
Abrupt withdrawal after prolonged use may cause adrenal insufficiency.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HOSTACORTIN H 5MG 30 TAB.	SANOFI	12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.	ARAB DRUG COMPANY (ADCO)	24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)	KAHIRA	250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.	EIPICO	69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.	EVA PHARMA	79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.	ANDALOUS PHARMA	84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.	SANOFI WINTHROP > SANOFI	84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solid	RAMEDA	7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	9.50 EGP

ALLOPURINOL

2nd line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg once daily, titrate by 100 mg monthly to target urate <6 mg/dL - long-term

Paediatric dose

Specialist use in pediatric hyperuricemia

Choice

Alternatives. Allopurinol is the first-line urate-lowering agent and the cheaper (6-39 EGP against 64-147); febuxostat is for when allopurinol cannot be used.

Dose source

ACR Management of Gout 2020 for the treat-to-target strategy, with the dose from Allopurinol tablets US prescribing information, section 2.3 Recommended Dosage for Gout (DailyMed SetID 211e47c6-85b9-43e8-9e07-6cc4b8f708a0): "Patients with normal kidney function: Initial dosage is 100 mg orally daily. Increase by 100 mg weekly increments until serum uric acid of 6 mg/dl or less is reached (maximum 800 mg daily)." The label's titration step is weekly against the monthly step given here.

Why

Xanthine oxidase inhibitor that lowers serum urate to prevent future flares and tophus formation; first-line long-term urate-lowering therapy, started only once the acute flare has settled and with flare prophylaxis co-prescribed.

Cautions

Do NOT start during acute flare; co-prescribe colchicine/NSAID prophylaxis.
Dose adjustment is mandatory in renal impairment.
There is a risk of severe cutaneous adverse reactions (SCAR).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
NO-URIC 100 MG 50 TABS.	EIPICO	12.00 EGP (0.24/unit)
URIC PURE 100MG 50 TAB.	MEPACO	13.50 EGP (0.27/unit)
LESSURIC 100MG 20 TAB.	ALEXANDRIA	6.00 EGP (0.30/unit)
ZYLORIC 100 MG 30 TABS.	GLAXO SMITHKLINE > ASPEN PHARMA TRADING LIMITED	39.00 EGP (1.30/unit)

FEBUXOSTAT

2nd line

Strength80 mg

Formoral.solid

Adult dose and duration

40 mg once daily, increase to 80 mg once daily if urate >6 mg/dL after 2-4 weeks (max 120 mg daily) - long-term

Paediatric dose

Not recommended in children

Dose source

Why

Alternative xanthine oxidase inhibitor for urate-lowering when allopurinol cannot be used or is not tolerated; reserved for patients without established cardiovascular disease given its cardiovascular safety signal relative to allopurinol.

Cautions

FDA warning: there is an increased risk of cardiovascular death versus allopurinol.
Avoid in established CV disease unless allopurinol intolerant.
Monitor liver enzymes baseline and periodically.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
EFFECTURIN 80 MG 20 F.C. TABS.	WESTERN PHARMA	64.00 EGP (3.20/unit)
FEBUMAGICTAM 80 MG 30 F.C. TABLETS	MEDIZEN PHARMACEUTICAL INDUSTRIES > MAGIC PHARMA-EGYPT	105.00 EGP (3.50/unit)
UNSIATEM 80 MG 30 TABS.	LIPTIS	114.00 EGP (3.80/unit)
ANDOURISTAT 80 MG 20 F.C. TABLETS	ANDALOUS PHARMA	80.00 EGP (4.00/unit)
STATURIC 80 MG 30 F.C. TABS.	MASH PREMIERE	123.00 EGP (4.10/unit)
XANTHIBUX 80 MG 20 F.C. TABS.	MEDIZEN PHARMACEUTICAL INDUSTRIES	86.00 EGP (4.30/unit)
FEBURIC 80 MG 30 F.C. TABS.	HIKMA PHARMA	139.50 EGP (4.65/unit)
XANTHISTOP 80 MG 30 TABS.	SEDICO > INSPIRE PHARMACEUTICAL COMPANY	147.00 EGP (4.90/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.