Febuxostat may be used second-line in people with chronic symptomatic gout who are intolerant of allopurinol, or for whom allopurinol is contraindicated. It should not be started until an acute attack of gout has completely subsided, as the drug may precipitate further attacks.

• The recommended oral dose is febuxostat 80 mg once daily. If the serum uric acid (SUA) level is greater than 360 micromol/L after 2–4 weeks, the dose may be increased to 120 mg once daily, aiming for a therapeutic target SUA level of below 360 micromol/L.
• The febuxostat Summary of Product Characteristics recommends gout flare prophylaxis with a nonsteroidal anti-inflammatory drug or colchicine, for at least 6 months. If a gout flare occurs during treatment with febuxostat, it should not be discontinued. See Recurrent gout for more information.
• Febuxostat is not recommended in people with ischaemic heart disease, congestive heart failure, or malignant disease and its treatment.
• No dose adjustment is needed for the elderly, or those with mild or moderate renal impairment. Febuxostat has not been fully evaluated in people with severe renal impairment (creatinine clearance < 30 ml/min).
• Liver function tests (LFTs) should be checked before starting febuxostat treatment, as mild liver test abnormalities have been observed. LFTs should be checked periodically thereafter, based on clinical judgement. In people with mild hepatic impairment, febuxostat 80 mg is recommended. There is limited information regarding the use of febuxostat in people with more severe hepatic impairment, according to the Summary of Product Characteristics.

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