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.
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 may cause 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 may be 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 may 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.
8 replies to "Gout and Diuretics"
I started using blood pressure pills at age 53 in 2/2017. Lisonop/Hctz 20-12,5 mg
was formula. Already in 8/17 I had slight gout attack but it went away in one week. In 9/18 I had series of strong gout attacks. Had to take prednisone like for 5 days 3X3. I had problem to go to WC and so for a few days or so at multiple occasion.
A doctor change my medicine to Lisonop 30g. First day I felt massive lowering of tingling in my joints. So because of it I stop using right away Allopurinol. 45 days after at Lisonop 30g all my gout and tingling is gone even I didn’t use one pill of all in that period. I’m not sure Lis 30g work best for me as I feel higher blood pressure but definitely less than without any pills. Probably will have to talk with doc about new pills.
Another huge problem for me that none machine can properly test my blood pressure. I have, I guess and hope is not bs, very hard muscle as I work in construction and work out with weights for 30-40 years. Store machine can not read my blood pressure at all, if I go to emergency machine there read me at 220/170, my omron read me at 170/105 and a Chinese women that work like helper to doctor usually read me at 150/90. So sadly my best reader is busing that I hear in ears.
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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?
Regards
Nick Iacovou
(South Africa)
PS – thank you for a highly informative website and advice.
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!
Nick, I’m not a doctor either but I would definitely be changing something. I know that excess weight causes the body to produce more Uric Acid from what I’ve read , If hypertension medication is a diuretic, which makes sense because hydration has a big affect on blood pressure then I would say the risk is very real. At this point I would say with complete empathy that if you don’t take control of the situation things will probably get worse at some point. Drs and even some naturopaths have lost my faith but if you question them and compare it to what you have read then you can usually dig yourself out of any hole that health challenges my present. I never never ever trust any one single health professional more than I trust my own judgment, many of them just want to sell you a product that you will have to stay reliant on instead of getting to the root cause and providing real treatment, natural or not I think this is wrong and dishonest. Empower yourself through knowledge and you’ll be amazed at the money and time you save. All the best Nick.
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