Lasix (furosemide) as a cause of Secondary Gout

[Junior GoutPal]

In Diuretics Cause Gout, I explain how many diuretics, prescribed for various health problems, can cause gout. Also, because gout usually stops when we change to gout-friendly diuretics, we call this secondary gout.

Among the list of diuretics in that explanation is a loop-diuretic: furosemide. Which is normally sold under the Lasix brand. As Lasix is a common cause of secondary gout, we get lots of questions about it. So, I will add old questions about Lasix/furosemide to this topic.

[Junior GoutPal]

Hello all:
I was put on Lasix back in Oct/Nov of 2015 for congestive heart failure – so about 9 months ago. Just this past week I began to get the symptoms of gout in big toe, then instep etc. I have taken cider vinegar and cherries plus cherry juice to help but my question is this: If I can get my doctor to take me off of the Lasix, what are my chances of that “curing” my gout problem? Just as an FYI, my lastest ejection fraction for my heart has gone up 15 % since March – so I believe I am on the right road to recovery for that and not sure why/if I need the Lasix any more.
Many thanks,
Pat

[Keith Taylor]

Wow Pat!

Thanks for a great question. But, I feel a bit out of my depth.

I run GoutPal to help gout sufferers communicate better with their doctors. I try to help you know what questions to ask. I try to help you understand what your doctor tells you. So, when I’m faced with a situation of two life-threatening diseases together, my first reaction is: “I’m not a doctor!”

But, I remember discussing Lasix in the old gout forum long ago. It was with a kindly New Yorker with heart and gout problems. He felt let down by his doctor, and did his own research. So he could “train his doctor,” he said!

He taught me that Lasix is great for congestive heart failure. But, there’s a catch. Lasix (furosemide) is a well known gout-causer. I’ll come back to that in a minute.

Pat, I never heard of Ejection Fraction before. I now understand it’s a measure of how well your heart is performing. There are complex considerations regarding diastolic heart failure and systolic heart failure. That is well outside the scope of a gout forum. But common sense tells me that Lasix is probably keeping you alive. Please don’t even think about stopping it now. I’m only just getting to know you, Pat. I don’t want to lose you.

Anyway, let’s get back to Lasix. Lasix, is the most common brand of furosemide. There is a study titled “Effects of the uricosuric action by losartan on the patients taking furosemide”. Cozaar is the most common brand of losartan. There is a very specific treatment plan. It involves taking Lasix, which dumps your excess fluid (but increases uric acid concentration). Then, around 4 hours later, take Cozaar, which encourages uric acid excretion.

Please, Pat, do not take this as your treatment plan. This is a suggestion for you to discuss with your doctor. There are many other medicine combinations that should achieve heart failure treatment with uric acid control.

ACV (Apple Cider Vinegar) has no effect on gout, other than it’s placebo effect. Cherries and cherry juice have some small value in herbal gout treatment, but must be part of a much more comprehensive plan. In your case, I’ll go out on a limb, and say they are a waste of time and money. Unless, Pat, you have some radical herbal gout treatment plan that you are keeping from me. 😉

I hope this helps you, Pat. It’s a complicated subject, so please ask for clarification if I’ve assumed too much.

Thank you for raising this Lasix issue again. Lasix causing gout seems to be too common. I’ve covered it in the past, but I think I need to review and improve my guidelines for Lasix and gout. I’ll add an idea in the suggestion box.

[Keith Taylor]

I should have added that I’m a great fan of the placebo effect. I just think it’s inappropriate in this case.

More importantly, I’ve added my idea about Lasix guidelines for gout sufferers in the GoutPal Suggestion Box. The fact that you are reading this says you are interested in this topic. But, I won’t know that unless you click the Favorite link on that suggestion. Please click it now. 💡

[Junior GoutPal]

It seems Frusimide is the cause of the gout I have suffered recently, time after time for past 9 months. I have been taking this Diuretic for about 10 years with no problems. So I was trying to think what has changed. A year ago, I suffered a fall and subsequent seizures, due to a bleed to the brain I sustained.

I live half way up a mountain in Snowdonia, alone, no near neighbours and because of the seizures I have been unable to drive since last December, so have not been able to pop to the shop for fresh bits and pieces, as I did. I rely on Tesco to deliver my shopping. Now, I have described myself in the past as being ‘addicted to milk’, full cream at that !!!! But, since I have been rarely getting out my consumption of milk had dropped to zero most days, I drink my tea black so it rarely seemed a problem. I did take advantage when I could and buy milk, but it does not stay fresh long.

So, I came to the conclusion that was about the only change in my diet since I have been taking Frusimide. So, After a flare up in September I started drinking at least 1 litre of UHW milk per day. Prior to this I had had gout hopping from one joint to another, ankles, instep, knees and wrists, no more than a week or so apart. As I said I got back on my milk in September and Tuesday this past week was the first flare up I have since. The pain seemed so bad I think it was paying me back for any attacks I may have warded off !!!!!!! Jesus !!!!!

So does anyone think the milk does or has in the past, helped ???

Another question I have had little ‘cysts’ develop under the skin on my eyelids, about the size of a grain of sugar, might this be caused by Uric Acid Crystals ???

Last question, is there anyway of dissolving or dispersing the crystals already present in my joints, or is it possible to get the joints washed or flushed out ??

Rita Lloyd

Lasix caused my gout!

[Gout Patient]

Hi Rita

I think that Milk being mostly water, drinking it regularly probably flushed out uric acid from your system, or prevented dehydration. Stopping drinking milk probably increased your uric acid concentrations and therefore your gout. With regard to the recent attacks, these could be due to you uric acid levels dropping as a result of restarting your milk consumption.

[Patrick]

Rita,

I think the correct name of the drug you are taking is Furosemide, or the common name Lasix. It’s a diuretic, like you mentioned. The fact you are taking Furosemide more than likely be causing some Gout flares because the drug rids your body of excess fluids. If you are not properly hydrating, than the drug can make you dehydrated, which can lead to Gout flares.

It’s really a double edged sword for you. Take Furosemide to rid the body of excess fluid, but stay hydrated to help fend off Gout attacks. I’m not sure about the connection between milk and Gout, but maybe Keith might have a better answer for you.

A better question is why did your doctor prescribe you Furosemide in the first place? Do you have Congestive Heart Failure? Do you have Kidney problems? These are the most common reasons to prescribe that medication. It’s certainly not a anti seizure medication.

There actually might be a connection with certain health issues related to your medication, than with milk or milk products. Maybe

[Keith Taylor]

I agree with Patrick on Furosemide/Lasix. It’s a well known gout-causing med. If you search for it in my gout search engine (top-right of every page), you get loads of info. You will also see several old discussions, including some that explain certain gout patients who have had success with a Furosemide and Losartan combination. But, that’s something that you should discuss with your doctor. My gout search engine is fueled by Google. It accepts ‘Frusimide’ as a misspelling of furosemide.

On the whole, milk should be good for gout. That’s because it lowers uric acid, as part of a gout-friendly diet. But, no single food or drink can be good for gout in isolation. Success depends on milk, or any other helpful food item, being part of a healthy balanced diet. Also, this is part of uric acid management. Which is not the same as gout pain management.

Rita, you’ve probably raised more questions than answers. But, there are perfectly logical explanations for all aspects of gout. You should keep asking for clarification about the responses you’ve been given. That way, you’ll get to understand your situation better, and learn to control your gout.

Or, you could get your doctor to change your ‘Frumiside’ for something that doesn’t cause gout.

[Dianne]

Gout, Losartan, Telmisartan & Colbenemid

I have had gout for 25 years …mostly controlled…limited to left big toe I think so far…(gout began when I got off prescription dope when I got sober oddly enough-sober for 25 years in AA…seems damned unfair..but I digress)..took Allopurinol for 1 year after diagnosis, developed hideous allergy back in 1984…since then on Colbenemid, Lasix 10 mg and HCTZ 12.5 and about 6 years ago neph placed me on Telmisartan 80 MG when we could not get the bottom number below 90..regimen worked fairly well …twinges but nothing full blown. Lately lots more twinges related to next paragraph….

OK…developed lesion on my lower lip about 3 months which would not heal and have had red coloration in the skin of my lips for years which I just ignored…a lesion that would not heal finally caused me to say ok..what is this?. it’s apparently related to thiazide….it’s not cancer…we are sure of that…..quit the HCTZ (was taking 12.5 mg) and continued with the 10 mg of Lasix…10 mg of Lasix just is not getting it done as a diuretic (I also may have a sulfa allergy too-yes I know Colbenemid is sulfa based)….that did not work very well…. have tired Edecrin 12.5 as a non sulfa, non thiazide loop diuretic which is great for about 36 hours then toe really starts to twinge…that was yesterday’s experiment….so today am back on 20 mg of Lasix and considering trying losartan in lieu of telmisartan since losartan is supposed to have some urosincic efffects…there is lots of stuff on the web including this website (thank you so much for this website guys) about lasix at 7 and losartan at 11 or a similar regimen…take them on a certain schedule…

My GFR is 59, kidney values normal but GFR is 59 (low) due to the ratio of values…probably creatinine being too high….I am 62, white female, thin, 128 lbs, 5’7″…long distance walker and I run races too…virtually vegan..eat no animal protein except an occasional egg white…am watching protein…trying to stay around 21 to 28 grams daily since I know protein restriction works…

Am looking for anyone who has got some “experience, strength and hope” on this as we say in AA…

Thanks so much for any feedback on this…

Also, I know losartan is not very good at lowering BP which is another competing concern since my dad had a stroke at 47…bad gene pool…he was another alcoholic..just never got to AA…

Dianne

[zip2play]

You were wise to get off the HCTZ…it probably caused your gout in the first place if you were taking it pre-gout. For me, in addition to causing my gout, it consistently caused me run extremely low blood sodium…dangerous in the extreme. Doctor told me if I got my blood sodium SUDDENLY, I’d immediately pass out.

I am going to assume that you are a volume (salt sensitive) driven hypertensive because you were/are on 2 diuretics. Given that, you don’t want to abandon diuretics. For me, diuretics and beta blockers are the only drugs that work and beta blockers make me comatose and fat.

Here’s my experience: After 10-15 years on HCTZ (50 mg./day) I began to worry for my kidneys and asked to be switched to Lasix which researchers say has only about 25% of the gout complications of thiazide. I started on Lasix 40 mg. twice a day and 100 mg. Cozaar, the first of the ARB’s. This was pure serendipity as a gout sufferer.

Current regimen is 40 mg. Lasix in the morning and 50 mg. Cozaar (losartan) 4 hours later. This is fine if I am teetotaling and have my weight just right. If I drink and gain some weight my BP drifts upwards. I am thinking of doubling those doses for awhile: AM: 40 Lasix, 50 Cozaar, PM 40 Lasix 50, Cozaar (always with 4 hours between.)

Lasix is a VERY potent diuretic and is highly dose-dependent until you reach “dry weight”…you might not be taking enough. It also is fast acting, so 2 doses, 12 hours apart, are better than one. Since you are small, perhaps 20 mg. spaced 12 hours apart might give you what you want. If you take too much Lasix, you can tell…the additional dose doesn’t make you pee. When you are full of water and BP is breathtakingly high, a dose of Lasix will turn you into Niagara.

Yes, Cozaar is weak to ineffectual but is the ONLY antihypertensive that is uricosuric. I continue to take it only for that reason (and I have a lot ahead.)

Nobody with gout should ever take a thiazide. I am convinced that the number of gouties has doubled as a percent of the population since we were all put on thiazides in the 60’s. It too readily retains uric acid.

What kind of SUA do you run and are you free of attacks?

[Dianne]

uric acid is 5.1 on a scale of 2.5 to 7.0 for women…I finally quit taking all diuretics as of yesterday ….yesterday took nothing and today…..the HCTZ is thiazide/sulfa and Lasix is sulfa too..both were making my mouth turn red…instant reaction..doc prescribed Edecrin 25 mg…its an ancient non-sulfa diuretic..loop…very strong..ototoxic…that is causing my toe to twinge big time…cut that in half to 12.5…….so now am gonna ask the doc if I can just take Micardis 80 and Colbenemid (yeah ..I know its sulfa based too but damned if I am spending $240 for Uloric monthly…past two days fewer twinges..mouth is better…seems like the redness is dose dependent….no edema…walked 3.2 miles this morning..usually I do from 3 to 6 miles daily..usually, 6.2 miles is my standard…

Am vegan and am now doing very low sodium, no processed food, have not had a drink of alcohol for 25 years so that is not an issue..and am thin.

I really have not had a full-blown gout attack for 20 years..so I am thinking that if I can get off these diuretics completely and manage BP through diet/exercise and Micardis or maybe something else if Micardis cannot do it without diuretics…am just trying to keep my GFR

(59) out of the toilet until I am safely dead…been lining up kidneys from my best friend and spouse..but really do not want to go that way.

I try to stay around 21 grams of protein …no animal products at all…it really helps with gout…

Thanks for your response…felt like a dog wailing in the wilderness.

Dianne

[zip2play]

Dianne,

If you are going to wing it without drugs except for your ARB and Colbenemid, why not switch from Micardis (telmisartan) to Cozaar (losartan.) At least you’ll be using a uricosuric. Also, consider taking things down even one more notch and taking just probenecid, if your nephrologist thinks it will be okay with your diminished kidney. Keep the colchicine on hand for attacks which you might not get.

Some people get better BP numbers using a split Cozaar dosage, like 50mg. AM and 50 mg. PM.

Nothing to lose…if BP control isn’t good enough after a month, switch back to Micardis.

Remember though, I found out through my own experience that there are two distinct types of hypertensives: salt sensitive volume dependent hypertensives for whom the ONLY answer is diuretics about 25% of us; and renin-angiotensin driven hypertensives who get benefit from ARB’s, ACEI’s, calcium channel blockers, etc. For the unlucky 25%, the latter pile are about as useful as a handful of M&M’s.

And upside: MERCK JUST lost the Cozaar patent in April [2010], so it’s available for 6 months as the generic exclusive to TEVA. After October it will be generic for all manufacturers and it will become a penny drug. The only one of the ARB’s that will be cheap.

[original post July 20, 2010 at 9:19 am]

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