Gout and Diuretics: How Water Pills Affect Uric Acid and Flare Risk

When you take a diuretic, a medication that helps your body get rid of extra fluid by increasing urine output. Also known as water pills, it's often prescribed for high blood pressure or swelling. But for people with gout, a painful form of arthritis caused by sharp uric acid crystals building up in joints. Also known as podagra, it can make things worse.

Here’s the catch: many diuretics—especially thiazides like hydrochlorothiazide—make your kidneys hold onto uric acid instead of flushing it out. That means more crystals form in your toes, knees, or ankles, leading to sudden, burning flares. It’s not that diuretics cause gout, but they can turn a quiet condition into a full-blown attack. Studies show people on long-term diuretics are up to 60% more likely to have their first gout episode. If you’ve been on these pills for years and suddenly started getting joint pain, the link might not be coincidence.

Not all diuretics are the same. Loop diuretics like furosemide can also raise uric acid, but potassium-sparing types like spironolactone might not have the same effect. Some doctors switch patients from hydrochlorothiazide to alternatives like losartan, an ARB that actually helps lower uric acid. Others add allopurinol or febuxostat to keep crystals in check. If you’re on a diuretic and have gout, talk to your doctor about your options—don’t stop cold turkey. Blood pressure control matters too, and there are safer ways to manage it without triggering pain.

What you’ll find below are real comparisons and deep dives into how medications interact with gout. From how specific diuretics change uric acid levels, to what alternatives actually work, these posts give you the facts—not just warnings. You’ll see side-by-side breakdowns of drugs, what to ask your doctor, and how to spot when a medication might be doing more harm than good. This isn’t guesswork. It’s what people with gout need to know before their next appointment.