# Gout - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Colchicine — 0.5 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Prednisolone — 5 mg — oral.solid - Allopurinol — 100 mg — oral.solid - Febuxostat — 80 mg — oral.solid ## Complete treatment card ```text GOUT 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Gout" - disease-level clinical article Status traced to the source above 1. COLCHICINE [1st line] Adult 1 mg initially, then 0.5 mg 1h later (max 1.5 mg per course) x 3 days Peds Specialist use only in children 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. Caution 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. Egypt 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) 2. IBUPROFEN [1st line] Adult 400-800 mg TID with food for acute gout flare x 5-7 days Peds 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. 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. Caution 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. Egypt 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 > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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. 4. PREDNISOLONE [1st line] Adult 5 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses. x 5 to 10 days Peds 0.1-2 mg/kg/day (Children: 0.1 to 2 mg/kg/day orally in 1 to 4 divided doses.) 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 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. Caution Use with caution in patients with diabetes mellitus, hypertension, osteoporosis, or active infection. Abrupt withdrawal after prolonged use may cause adrenal insufficiency. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 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 RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid 5. ALLOPURINOL [2nd line] Adult 100 mg once daily, titrate by 100 mg monthly to target urate <6 mg/dL - long-term Peds 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. 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. Caution 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). Egypt 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 SMITHKL... 39.00 EGP (1.30/unit) 6. FEBUXOSTAT [2nd line] Adult 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 Peds Not recommended in children Source 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. 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. Caution 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. Egypt EFFECTURIN 80 MG 20 F.C. TABS. WESTERN PHARMA 64.00 EGP (3.20/unit) FEBUMAGICTAM 80 MG 30 F.C. TABLETS MEDIZEN PHARMACEUTICAL IN... 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 PHARM... 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 > INSP... 147.00 EGP (4.90/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)