Indocin vs. Allopurinol for Gout: Important Differences and Potential Risks.

Key takeaways

Indocin (indomethacin) and Zyloprim (allopurinol) are both prescription medications, but they treat different conditions and belong to different drug classes. Indocin is an NSAID used to treat various types of arthritis, shoulder pain, and gouty arthritis by reducing inflammation and pain. It is available as a tablet, supsension, and rectal suppository, which can be beneficial for those who have trouble swallowing pills. On the other hand, Zyloprim is a xanthine oxidase inhibitor that lowers uric acid levels to treat gout, prevent kidney stones, and manage tumor lysis syndrome in cancer patients. Zyloprim is taken orally daily and can be split into smaller doses if needed. While Indocin can cause serious side effects like stomach bleeding and heart issues, Zyloprim may lead to severe skin reactions and liver problems. Both medications have generic forms available, making them more affordable options.

Indomethacin

(Indocin)

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Allopurinol

(Zyloprim)

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Summary for Indocin

Prescription only

Indomethacin (Indocin) is an NSAID that's used to treat different types of arthritis, including arthritis related to gout. It's also used to treat conditions that cause shoulder pain. This medication can be used in people 15 years of age and older; it hasn't been studied in younger children. The oral form of indomethacin (Indocin) is available as capsules (both immediate-release and extended-release) and a liquid. The dosage for immediate-release formulations is typically 2 to 4 times a day, and the dosage for extended-release capsules is once a day. Common side effects include headache, dizziness, and stomach upset.

Indications for Indocin

Moderate-to-severe rheumatoid arthritis, including flare-ups
Moderate-to-severe ankylosing spondylitis
Moderate-to-severe osteoarthritis
Shoulder pain caused by bursitis or tendonitis
Gouty arthritis - all forms except extended-release (ER) capsules

Pros and Cons for Indocin

Pros

Can relieve pain and swelling
Available in fast-acting formulations and a longer-acting, extended-release capsule
Dose can be adjusted by your provider if needed
Liquid version is a good option for people who have trouble swallowing pills

Cons

Might not be the best option for long-term use because of safety risks
Most forms are taken 2 to 4 times a day
Not a good choice if you have kidney or liver problems
Can raise your risk of blood clots, heart attack, or stroke (similar to other NSAIDs)

Common Side Effects for Indocin

Note: Side effects listed here are for immediate-release indomethacin. Side effects for extended-release capsules might differ.

Headache (12%)
Nausea (up to 9%)
Upset stomach (up to 9%)
Dizziness (up to 9%)

Warnings for Indocin

Stomach bleeding and ulcers
Heart attack and stroke
High blood pressure and heart failure
Liver problems
Kidney damage and high potassium levels
Severe allergic reactions
Severe asthma attack
Worsening of nervous system and mental health problems
Harm to unborn babies

Summary for Allopurinol

Prescription only

Allopurinol (Zyloprim) is a xanthine oxidase inhibitor that lowers uric acid levels in the body. It's used to treat gout in adults. This prescription medication can also prevent recurrent calcium oxalate kidney stones in adults. In addition, allopurinol (Zyloprim) helps prevent tumor lysis syndrome in people with cancer who are taking certain chemotherapy (cancer medications). Allopurinol (Zyloprim) is a lower-cost generic tablet that's taken by mouth. Side effects are generally mild but can include diarrhea and nausea.

Indications for Allopurinol

Gout in adults
Prevention of tumor lysis syndrome from certain chemotherapy medications in adults and children with cancer
Recurrent calcium oxalate kidney stones in adults

Pros and Cons for Allopurinol

Pros

First-choice option for treating gout
Can take with or without food
Available as a lower-cost generic

Cons

Might raise the risk for gout attacks in the first few weeks (since your uric acid levels are rapidly changing during this time)
Can cause kidney stones, especially in people who don't drink a lot of fluids
Possible risk for low blood cell levels and liver damage