Gout and Diuretics

Gout and Diuretics

Can Diuretics Trigger a Gout Attack?

A possible connection between the use of diuretics and the sudden development of gout was first identified more than 25 years ago but the medical community is unsure if the diuretic or the underlying hypertension is the main culprit. If you have high blood pressure and more importantly use diuretics which is a prescription drug commonly called water pills, to help lower your blood pressure; then studies now show that you are at risk of developing gout. Middle aged and elderly people are more prone to use diuretics, so they are in fact more at risk in the complication of developing gout with this type of drug.

Diuretics are a class of drugs that have been shown to increase your serum urate levels. Diuretics work to decrease the fluid volume of your blood thus lowering your blood pressure by having less blood flowing through your arteries and blood vessels. Since diuretics tend to have fewer side effects than other anti-hypertensive drugs, doctors tend to prescribe them more often. How diuretics work exactly for the high blood pressure sufferer, is that they cause you to produce more urine than normal in order to flush out the surplus fluid in your blood. They stimulate the kidneys to expel more water in the form of urine.

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The Evidence That Water Pills Can Cause Gout

According to one study conducted by Mara A. McAdams DeMarco, PhD, of Johns Hopkins University in Baltimore and appeared in the January 2012 issue of Arthritis & Rheumatism, your chances of developing gout or a gout attack increased by 1.48 fold. The risk of gout was also increased with both thiazide and loop diuretics. This study followed 5789 participants who had hypertension but no gout for 9 years. Also noted was the fact that when using other anti-hypertensive drugs to treat high blood pressure, that this decreased the risk of developing gout. DeMarco and colleagues also stated: “Future studies should not only confirm the risk of gout associated with diuretic-induced hyperuricemia but also further elucidate the complicated relationship of hypertension, diuretics, uric acid, and gout.” Basically more work needs to be done to connect all the dots.

Taking diuretics or so called water pills can cause you to develop what is considered secondary gout and not primary gout which is more often hereditary or diet related. Secondary gout is usually due to the fact that gout occurs only after taking medications such as water pills to treat any other type of condition or disease. What water pills do is that they remove the excess water from your body and this causes uric acid levels to increase. Yes, if you have never had gout, nor a gout attack before and are using diuretics to treat your high blood pressure, you are at risk of developing gout. If gout does occur then discuss with your physician about changing to other types of anti-hypertensive drugs such as calcium channel blockers that do not lessen bodily fluid.

If you already have gout taking diuretics can increase your risk of developing gout attacks. Your doctor then will most likely prescribe you either allopurinol, colchicine, phobenecid or NSAIDs to get rid of uric acid before it crystallizes and causes you a painful gout attack. It is very important to get your uric acid tested and ensure that you get it down to 5mg/dL or lower.

Posted by Spiro Koulouris

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  • Nick

    Reply Reply February 12, 2018

    Good Day Spiro

    I am 51 yrs old and approximately 18 months ago was diagnosed with Hypertension. The prescribed medication initially caused me to have bouts of coughing fits so the doctor changed my medication 2 or 3 times to counteract the side effects.

    About 7 months ago I started have severe ankle pains, mainly in my right ankle, but occasionally on the left one too.
    My pharmacist tested me for gout and said i have ‘high uric acid’ and gave me a pack of Cochicine Houde as an emergency treatment and Puricos 100 to take daily thereafter.
    The pain subsided for a few days and then came back with a vengeance.
    I went back to my doctor, who confirmed that I have gout and prescribed Puricos 300 to me.
    During the time of my initial High Blood Pressure diagnosis and early bouts of gout, I did stop smoking and gained approx. 20kg to add to my 110kg initial weight.

    Since then, I have still been getting, what I assume is gout attacks, mainly in my left ankle and occasionally in both, every 5 to 7 days and last for a day or three. I basically get by, by taking 2 or 3 anti-inflammatory pills daily to ease the pain.
    I am pretty sure the frequency of the flare ups is quite unusual & I do try and avoid ingesting food and drink which is gout un-friendly. I do not drink any alcohol at all either.

    I have lost faith in my doctor and at my wits end as I work on my feet quite a lot and I spend most of the day limping around.

    My question is –

    Could the Hypertension Medication (Zartan 100mg, Spiractin 25mg, Mylan Furosemid 40mg & Ecotrin 81mg) be causing these almost continuous Gout attacks as a side effect?
    Would it be advisable for me to stop my Hypertension medication and see if the Gout symptoms dissipate or disappear altogether?

    Nick Iacovou
    (South Africa)

    PS – thank you for a highly informative website and advice.

    • Spiro Koulouris

      Reply Reply February 12, 2018

      Ouch Nick!

      I feel your pain.

      Unfortunately I am not a doctor and can only provide nutritional advice. If you are not happy with your doctor, go out and seek the advice of another 2 doctors, preferably rheumatologists who are specialists in arthritic diseases like gout. Somebody should get it right and fix your issue.

      Good luck!

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