• Chronic management of hyperuricemia in patients with gout who have an inadequate response to a maximally titrated dose of allopurinol, who are intolerant to allopurinol, or in whom allopurinol is not an appropriate treatment option.

Contraindicated in:

• Concurrent use of azathioprine or mercaptopurine.

Use Cautiously in:

• Cardiovascular disease (↑ risk of cardiovascular death compared to allopurinol) (consider using low-dose aspirin when using febuxostat in these patients)
• Severe renal impairment (CCr <30 mL/min)
• Severe hepatic impairment
• Previous skin reaction with allopurinol
• OB: Use during pregnancy only when potential maternal benefit justifies potential fetal risk
• Lactation: Safety not established in breastfeeding
• Pedi: Safety and effectiveness not established in children.

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), rash, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS.

GI: ↑liver enzymes, nausea.

MS: arthralgia, gout flare.

Drug-Drug:

• Significantly ↑ levels of and risk of serious toxicity from azathioprine and mercaptopurine; concurrent use contraindicated.
• May ↑ levels of theophylline; use cautiously together.

(Generic available)

• Tablets: 40 mg; 80 mg;

• PO (Adults): 40 mg once daily initially; if serum uric acid does not ↓ to <6 mg/dL, ↑ to 80 mg once daily.

Uloric

• Decreases production of uric acid by inhibiting xanthine oxidase.

• Lowering of serum uric acid levels with resultant decrease in gouty attacks.

Therapeutic Classification: antigout agents

Pharmacologic Classification: xanthine oxidase inhibitors

Absorption: Well absorbed (49%) following oral administration.

Distribution: Widely distributed to tissues.

Protein Binding: 99.2%.

Metabolism/Excretion: Extensively metabolized by the liver; minimal renal excretion of unchanged drug, 45% eliminated in feces as unchanged drug, remainder is eliminated in urine and feces as inactive metabolites.

Half-life: 5–8 hr.

(plasma concentrations)

*Maximum lowering of uric acid may take 2 wk.

• Instruct patient to take febuxostat as directed. If a gout flare occurs, continue febuxostat and consult health care professional; medications to manage gout flare may be added.
• Advise patient to notify health care professional if rash, chest pain, shortness of breath, dizziness, rapid or irregular heartbeat, or stroke symptoms (weakness, blurred vision, headache, confusion, slurred speech) occur or if side effects are persistent or bothersome.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Emphasize the importance of follow-up lab tests to monitor therapy.

fe-BUX-o-stat