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Prednisone for Gout: Alternatives + A Pharmacist’s Guide

Prednisone for Gout: Alternatives + A Pharmacist’s Guide

Has your doctor prescribed prednisone for gout? Is it working? And if so, how fast should it work?

Prednisone is truly a miracle drug. It saved my life.

For others, prednisone may not work immediately or ever. Has it worked well for you?

Watch now!

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Prednisone for Gout: Alternatives + A Pharmacist’s Guide

Transcription autogenerated from the video above so some errors are possible

These are questions you might have about prednisone as used as a treatment for gout.

This article and video was triggered by a prednisone warrior who said;

I just had a gout attack. The doctor prescribed one pill a day for a week. It seems wrong and it doesn’t seem to be working. Is it going to work for everybody? And how much should we be taking? 

What is Gout?

Gout is an inflammatory condition that can make your joints swell, get red, hot and painful. The most common joint is the bottom of the big toe. It could be any other joint, hand, wrists, shoulders and knees. But the most common is the big toe. 

There are different occasions when you might use prednisone for gout. You might use it the first time you get gout and you might use it when you have a relapse when it comes back. Or you might be like me and have a condition called Pseudo gout, which is calcium pyrophosphate deposition disease or chondrocalcinosis. Most of you don’t need to worry about that. It’s pretty rare and it’s usually in really old people. 

What are Typical Doses of Prednisone for Gout?

The general dose is 40 milligrams a day until the flare resolves. You would take either two 20-milligram tablets or four 10-milligram tablets and you could even do eight five-milligram tablets. You won’t need to take that many, but you take them all at once. The second you get that prescription and you do that until the flare resolves. Until your pain is going away, generally that means five to seven days of treatment.

And the most important thing to know is that the sooner you take it, the better. If you start taking treatment the moment you start having symptoms. You’ll probably need to take fewer drugs over time. Start as soon as you possibly can. It says 5-7 days of treatment if started within 12-36 hours of symptom onset. This information came from the UpToDate Online Medical Information Database.

How to Taper with Prednisone for Gout?

You should take it during that flare while you’re having that terrible pain. And then it’s important to taper it. Taper means to slowly drop the dose over time. If you started at 40 milligrams, then you might go to 30, 20,10, 5, and then off. They want you to do that over 7-10 days if it’s your first time or if you don’t have very frequent relapses.

But if it’s taken, if you’re getting frequent relapses, you’d want to taper over a longer period of time, such as 14-21 days. Two to three weeks after your flare stops, you’d wanna slowly go off because it might come back. If you suddenly stop taking the prednisone, you’ll have a more likely chance that the flare will come back soon.

I saw somebody talking about how he only takes it for 1-3 days and then he has to do that multiple times a month. And that’s not what we want. We want you to take it for one to three days and then slowly taper off so that it’s not coming back multiple times a month. That’s terrible. 

How fast does prednisone work for gout?

If you were to take it, when do you get symptom relief? How fast does prednisone work for gout? In one scientific study, showed that 43% of people who took 30 milligrams had improvement in pain after 48 hours. About half of the people at about 2 days had pain relief. Another dose of 60 milligrams showed 52% of people at two days. Somewhere around half the people get pain relief at around two days.

Another source is the US Pharmacist, who said that; 

Symptom improvement, which should occur in two to five days. 
Comment #1 How Prednisone Works with Gout

When the first person who asked me about this said; 

It doesn’t seem to be working well, that’s possible in about half of people that it might not work. 

Who knows? But these people who commented on how prednisone is working for their gouty arthritis. These are their comments and clear they worked for them and they’re fascinating. One person said;

Comment #2 How Prednisone Works with Gout

I get 85% relief after one to three days. 

Awesome. Another one said; 

Comment #3 How Prednisone Works with Gout

Thank you Prednisone, you are my best friend. Within three hours I could walk with a limp and with just a little pain. By morning I could wear a shoe on my foot and the swelling was almost completely gone. 

So that’s awesome. Like three hours to a day the swelling’s down. Another person said;

Comment #4 How Prednisone Works with Gout

This drug is amazing. I don’t believe in miracle drugs, but this is pretty dang close. After eight hours of taking my first dose, 80 to 90% of the pain is gone. 

Woo, that’s awesome. Another person said;

Comment #5 How Prednisone Works with Gout

The results have been amazing. I took my first dose of four tablets and the pain subsided within less than two hours to the level that I could actually walk. 

So we’re getting one to three days to two hours here. And finally this person said; 

Comment #6 How Prednisone Works with Gout

I’m so grateful to the doctors, they prescribed me prednisone. After two hours of taking it, my ankle subsided. I went to bed, woke up feeling like a million bucks. 

And then finally prednisone works within hours. For some people, it’s within two hours to two days. For other people, it might not work at all.

How Prednisone does work with Gout?

How is it working? Prednisone is working because it’s an anti-inflammatory. It’s the ultimate anti-inflammatory and it works by decreasing inflammation, swelling, redness, and pain. All of those things are just kind of being turned off because it’s shutting down the inflammation pathways, which is amazing unless it doesn’t work or it’s causing lots of side effects. 

Let me tell you some side effects for people who took it for gout. One person said; 

Comment #7 Prednisone Side Effects as a Treatment for Gout

I got hand cramps, body cramps, blurred vision, runny nose, insomnia, and I just feel bad. 

Another person said; 

Comment #8 Prednisone Side Effects as a Treatment for Gout

I just wanted you to know that I only take the 60 milligrams when I have to. It does a number on my entire system. But with all that said, none of the side effects come close to the pain for my arthritis, none. 

While prednisone can definitely cause side effects in this case, this person said it is worth it because the pain from the gout arthritis is just so horrible than any of those side effects are worth it to him. 

Another person said;

Comment #9 Prednisone Side Effects as a Treatment for Gout

It sends sugar readings high for a day or perhaps too.

Other people have taken prednisone for many other conditions and have suffered up to 150 side effects and have said; 

Comment #10 Prednisone Side Effects as a Treatment for Gout

I cannot believe my doctor prescribed this. This thing is the worst thing ever. No one should be allowed to take it. 

You can hear both ends of the spectrum. Some people think the side effects are so terrible and other people think prednisone is a complete miracle. And it is both. It depends on your situation and your personal side effect profile. 

These are the side effects I personally experienced everything from hair loss to insomnia to moon face. It can be horrible. I had to take it on for eight to nine months though, and most people who take it for gout do not have to take it that long. Hopefully you don’t get the big moon face and weight gain and all of those horrible things. 

Alternative Treatment for Gout

If prednisone isn’t working for your gout, what are some alternatives that you could try? 

Some of them are available right there in your medicine cabinet such as ibuprofen, naproxen, and indomethacin. It isn’t necessarily in your medicine cabinet, but they’re over-the-counter NSAIDs, non-steroidal anti-inflammatory drugs. 

The most important thing is to take it as soon as you possibly can. The moment you start, you start feeling symptoms, you should start getting that anti-inflammatory to stop the progression. Because what’s happening is, it’s kind of a cascade or like a ball rolling down a hill, picking up inflammation as it goes. If we can just stop that immediately, the sooner you stop it, the less of a cascade of problems you’re gonna have to deal with.

So the problem with things like ibuprofen, naproxen indomethacin, and celecoxib is that for people who have kidney or liver disease or bleeding problems, it’s just not very safe for them and could make those situations worse. 

Another option is Colchicine. It is a super old drug that was recently rebranded and became more expensive, but it works quite well. The only problem is it can cause stomach upset such as diarrhea, nausea, vomiting, and stomach pain. I’ve personally been taking Colchicine for almost six months now because again I have pseudo-gout. I have joint issues and it really works well. 

Definitely did cause stomach upset and sometimes I have to take two a day, but generally just one a day. That can be a pretty common thing in people who have gout that comes back that you take just a low dose of Colchicine to prevent issues going forward. And it’s something that I’ve had to do and many others and it’s okay. It’s not particularly harmful to be on long-term. 

There are a few rare side effects to be aware of, but again, they’re rare. One thing you can do is that Colchicine is obviously interfering with your gut and according to the natural medicines database, colchicine might reduce the absorption of vitamin B12 and increase the risk efficiency.

Vitamin B12 + Colchicine

Vitamin B12 is vital for your body, whether it’s for your nerves or your blood. If you are going to be taking Colchicine longer term, I definitely recommend taking vitamin B12 as well to decrease your risk for anemia and other complications you might have. 

And how does it do that? Colchicine disrupts the normal intestinal mucosal function leading to malabsorption of sub nutrients including vitamin B12. Definitely consider taking B12 along with Colchicine if that’s what you have to take instead. If you are the type of person who’s had not just one but more than one episode of gout, your doctor might be saying something to prevent it. And the ultimate goal is to get the uric acid levels down.

Why do we care about Uric Acid?

The urate or the uric acid crystals are depositing inside the joint and we need to get the urate levels down. How can we possibly do that? 

There are prescription medications and there are some lifestyle changes that we can do. First I’m gonna talk about prescription medications because I am a pharmacist and then I will talk about some possible ways we can improve our health that can potentially decrease our risk for gout.

Medications to Lower Uric Acid Level

First, what medications might help? Medications might help include things that lower the uric acid level. They’re called urate-lowering therapies ULT, as an acronym for them.

We have Allopurinol a super old drug that works really well and it’s the most common drug. It’s fairly inexpensive, but you have to be careful if you have certain genetic issues or kidney or liver problems. We just wanna keep the dose safe for you. So be sure to work closely with your doctor to make sure it’s safe for whatever complications you might have. 

A related drug is called Febuxostat, and its brand names are Aric and Adenuric. That’s a great alternative if you can’t use Allopurinol. And then Proben is another older drug that’s less commonly used now that we have these alternatives.

Finally, if nothing else is working for you, they have an IV specialty expensive medication that they can inject called Krystexxa or Pegloticase. The only problem is it only works about half the time and it can have severe allergic reactions. It’s pretty much a last-ditch resort, but I’m just grateful that such things exist. 

And then while you’re starting these urate-lowering therapies, you may need to continue taking Colchicine for several months while your acid level is lowering because it takes a while. These urate uric acid crystals don’t just fall apart instantly when we take these drugs, it takes a lot of time. Be sure to follow what your doctor recommends as far as your colchicine or your urate-lowering therapies.

Lifestyle to Decrease your Risk for Gout

As promised here are some lifestyle changes that may help to decrease your risk for gout. These include losing weight. Benjamin Franklin had gout and he didn’t have the luxury of any of these treatments back in his day they called gout a rich man syndrome. It was basically gout was considered something that only rich people could afford to have because it generally was associated with weight gain.

And poor people were generally malnourished and lower in weight and it’s associated with a higher intake of meat, which generally poor people can’t afford. Alcohol intake is basically when we act like a poor person, it’s potentially a way that we can decrease our risk for gout complications and flares. Losing weight, getting our blood pressure under control, supporting our kidneys, not fasting. Okay, that would be a poor person thing, and don’t want to be a rich person thing, but we also don’t wanna have prolonged fasting. Either of those is affecting our purine levels. 

Purine is related to urate. We want to keep the amount of food steady.

We don’t want to overeat and we don’t want to fast too much. Just keep it a consistent amount. 

Alcohol consumption

Consuming excessive amounts of alcohol, particularly beer, whiskey, gin, vodka, rum, and other spirits on a regular basis increases your risk. Not taking alcohol is wise when it comes to preventing gout and then consuming large amounts of meat or seafood. We don’t want to do that. small amount or minimizing it as much as possible.

Beverages to Avoid

 And then this is something that is prevalent in America for sure. It’s consuming beverages containing high fructose corn syrup such as nondiet sodas. High fructose corn syrup is found in everything from ketchup to coke and you want to check the label and make sure you don’t have that in there because that is increasing your risk for a gout flare and weight gain and diabetes and all sorts of things. So avoid things that contain high fructose corn syrup. 

Drug Interaction

And finally, one possible cause of gout flares is medications that affect the urate levels such as diuretics. This is basically like a drug interaction and we want to talk to your doctor and pharmacist, ask if it’s worsening your gout. They can check it out and make sure that everything you’re taking is safe for somebody who has gout. Because there are alternative medications that you could be taking instead of those. So I’d recommend doing that. 

And then potential things that could increase your risk for gout include an injury or recent surgery because it would be releasing things into your blood that might increase your urate levels.

Fasting, consuming certain amounts of alcohol, overeating, taking medications that induce a sudden change in your blood urate levels, and dehydration. So that’s the final thing that you’d want to do is stay hydrated with water. Preferably not alcohol, not high fructose corn syrup containing beverages. 

Drinking liquid to avoid dehydration is really important because when there’s not enough water in your blood, those crystals are more concentrated and that can increase your risk for pain and swelling, inflammation, and all of the things. Those are ways you can decrease your risk for gout. 

If you have other questions about prednisone, please comment below. And if you will find that you have to take Prednisone more than once a year, then I would definitely recommend taking supplements to support you while you’re using Prednisone. To decrease your risk for side effects and help you feel like yourself again. Instead of having insomnia, trouble sleeping, weight gain, blood sugar changes, you can take supplements to support you, and some of those include melatonin to help with sleep. 

What’s the best supplement?

You can take chromium to help with the blood sugar changes. Vitamin D and calcium are important to help prevent osteoporosis. Especially if you’re gonna be taking the prednisone for more than two weeks. You would want to be supporting yourself with those. 

And if you’re wondering, what’s the best way to get that? I personally had to take prednisone and I have family members with osteoporosis. I did not want to have those risks. And I felt horrible while I was on prednisone.

All the side effects I was going through, I discovered that if we replenish the nutrients that prednisone depletes, from calcium, vitamin D, and chromium which is causing the weight gain and the sugar issues. If we replenish all of those, we feel so much better because we’re giving our body the nutrients it needs while on prednisone. 

I invented a supplement, I call it Nutranize Zonehttps://nutranize.com/product/prednisone-original/. It’s the first and only supplement for people on prednisone and it gives back all of those nutrients you need. Plus I found other supplement ingredients in here to help counteract other side effects. So just go to Nutranize.com and you can get it today to help support your body while you’re taking prednisone. Signing off as Dr. Megan, your Prednisone pharmacist.

References
  1. US Pharm. 2023;48(1):37-42. Link:https://www.uspharmacist.com/article/treatment-options-for-gout
  2. Gaffo AL, et al. UpToDate online. Link: https://www.uptodate.com/contents/treatment-of-gout-flares
  3. Patient education: Gout (The Basics). UpToDate. Link: https://www.uptodate.com/contents/gout-the-basics
  4. Natural Medicines. Therapeutic Research Center. Nutrient-depletion Tool. Link: https://naturalmedicines.therapeuticresearch.com/tools/nutrient-depletion.aspx#

Prednisone Taper Chart

Receive a free Prednisone Taper Chart to help you know when to taper down in prednisone dose. This does not substitute your doctor's prescription.

Dr. Megan Milne, PharmD, BCACP

Dr. Megan Milne, PharmD, BCACP, is an award-winning clinical pharmacist board certified in the types of conditions people take prednisone for. Dr. Megan had to take prednisone herself for an autoimmune condition so understands what it feels like to suffer prednisone side effects and made it her mission to counteract them as the Prednisone Pharmacist.

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