Are you taking HCTZ or HCT? Those are the abbreviations for hydrochlorothiazide. This “thiazide” diuretic is probably one of the most prescribed drugs in the world. By our count, over 20 million people pop a medication containing HCT every day in the U.S. It is found in lisinopril HCTZ, losartan HCTZ, triamterene HCTZ and valsartan HCT among many others. The diuretic raises uric acid levels. The result: hydrochlorothiazide triggers gout.
A Question from a Reader:
Q. I took hydrochlorothiazide (HCTZ) for about 15 years to lower my high blood pressure. Soon after I started taking it, I began experiencing episodes of gout.
Belatedly, I put the pieces together and realized that HCTZ was a major contributor to my gout.
Now I take tart cherries to lower my chances of gout and I have lost weight to bring my blood pressure down into normal range.
A. Gout is caused by a buildup of uric acid crystals in the joints. Since HCTZ can raise uric acid levels in the blood, it very well may contribute to gout. Congratulations on the healthy weight loss. Losing pounds can often bring blood pressure down.
Other Stories from Readers:
Jack in Marianna, Florida had an interesting roller coaster ride with HCTZ:
I have serious gout! The HCTZ is a major contributor to gout attacks. Doesn’t cause gout but increases the frequency and severity of attacks. I started HCTZ 15 years ago, and I also started having the violent attacks of gout then as well. I never knew the correlation until last month. I stopped HCTZ and replaced it with another medication and my gout attacks have subsided. Just saying.”
Tony also wasn’t told that hydrochlorothiazide triggers gout:
I was on HCTZ for more than 10 years. I suffered thru many episodes of gout, before I discovered that the HCTZ raised my uric Acid levels.
“I discussed this with my Internist, and he said he could put me on allopurinol [to lower uric acid levels] or take me off of the HCTZ. I chose the latter.”
Gout is Serious!
The pain of a gout attack can be unbearable. Gout can also damage joints. Although there are ways to lower uric acid levels it has always seemed a bit odd to us to try to counteract a side effect with another medicine.
If hydrochlorothiazide triggers gout in a person do health professionals really want to add allopurinol to solve that problem. Allopurinol can cause its own side effects including digestive tract upset, nausea, diarrhea, rash, itching, drowsiness, kidney and liver damage.
Tart Cherries for Gout:
Health professionals often think first of drug solutions for gout. We understand that. Medical education emphasizes pharmaceutical answers to common ailments. When non-drug options are discussed, many physicians assume that there is no science to support them. In the case of tart cherry juice, au contraire.
Animal and human research has demonstrated that tart cherries can reduce uric acid levels (Jacob et al, Journal of Nutrition, June 2003; Haldari et al, Malaysian Journal of Nutrition, Vol. 15, no. 1, 2009).
People who eat tart cherries or consume tart cherry juice may have fewer gout flares (Zhang et al, Arthritis and Rheumatism, Dec. 2012; Singh et al, Journal of Clinical Rheumatology, June 2015).
Stories from Readers:
Not everyone benefits from tart cherry juice. Let’s be totally clear about that. Some people do appear to get relief, however.
Linda in Wisconsin had success:
I have had gout a couple of times and since my parents too had suffered from gout I took my mom’s advice and drank the cherry juice. It works!!! That was years ago and if ever I have an inkling of the possibility of another attack I start drinking cherry juice.”
Eloise overcame a gout attack:
My first attack of gout came after I went on what I thought of as a health kick with lots of beans and peas at two meals a day. I did this for a week or so, but hadn’t yet gotten control of my soda habit (one step at a time, right?). The combination was a bad one, and I was soon in excruciating pain!
“Luckily, I had heard about Trader Joe’s Morello cherries. They’re cheap (about $3 for a large jar) and worked miraculously! I ate about a dozen, and within a couple of hours I started to feel relief.
“The pain was completely gone the next day! If it started to flare up, I ate 6 more and was completely back to normal in 3 or 4 days. I now keep them on hand, and if I ever feel an attack come on, I immediately run for my “magic cherries.” They’ve worked without fail!”
Celery Seed Extract for Gout?
Brett in Wisconsin shared this experience:
I was a long-time user of Allopurinol, and it was very successful in managing gout. However, I am not in favor of taking any medications if I can find an alternative. Last December I had a situation where my Allopurinol was misplaced. I was traveling so I had to go without for a week. At that time I decided to stay off the Allopurinol and try Celery Seed Extract. Four months later I have yet to have a flare up. My uric acid levels are normal and no prescriptions!”
People’s Pharmacy Perspective:
Hydrochlorothiazide triggers gout. There is no controversy about that, though some health professionals think it is a very rare side effects. A systematic review of the medical literature, however, describes thiazide diuretics like HCTZ as important contributing factors in raising uric acid levels and causing gout attacks (Current Opinion in Rheumatology, March, 2011):
Among medications, consistent evidence exists for thiazide and loop diuretics to be associated with higher risk of incident gout and higher rate of gout flares.”
Patients taking thiazide diuretics like HCTZ should have uric acid levels tested periodically. If they experience a gout attack they should discuss this adverse reaction with the prescribing physician to see if another medication might be more appropriate.