Febuxostat

Taken regularly, febuxostat can prevent damage to your joints, stop attacks of gout and reduce the size of gouty lumps affecting your skin.

The body naturally produces a substance called urate, which normally dissolves in the blood and is passed out in urine. In gout the blood cannot dissolve all the urate, so solid crystals form in and around joints causing inflammation and pain.

Febuxostat works by blocking the production of urate. This brings down the urate levels enough to allow the crystals to begin dissolving and prevent attacks of gout in the long term.

Before starting febuxostat most people will have tried another drug called allopurinol. Both drugs work in a similar way, but febuxostat is only used if your doctor suspects you might react badly to allopurinol or if you’ve had side effects from it.

Febuxostat is also known by the brand name Adenuric.

Urate lowering drugs, like febuxostat, are very effective for the long-term treatment of gout. They can be especially helpful if:

• you’re having repeated attacks of gout
• your joints or kidneys have been damaged by attacks of gout
• you have gouty lumps, called tophi.

However, febuxostat may not be suitable for everyone. Your doctor may decide not to prescribe febuxostat if:

• you’ve had a severe heart condition
• you have severe kidney or liver problems
• you have thyroid problems.

Your doctor will arrange for you to have a blood test before you start treatment to check your urate levels, kidneys and liver.

Febuxostat tablets contain lactose, so tell your doctor if you’re lactose intolerant.

Your doctor may advise you not to start taking febuxostat until after an attack of gout has completely settled. If this isn’t possible it may be started while the gout is in a mild phase.

It’s important to be aware that as the crystals begin dissolving they can become dislodged. Because of this, you may actually have more attacks of gout during the first few weeks of treatment.

This doesn’t mean the drug isn’t working, so don’t stop taking febuxostat, but do treat the attack as you would normally.

Attacks of gout normally stop within a year, once your urate level has been lowered sufficiently.

Febuxostat is taken in tablet form once daily with or without food. The tablet should be swallowed with water. Your doctor will advise you about the correct dose. Usually you’ll start with 80 mg daily, but your doctor will take regular blood tests and may increase the dose to 120 mg daily if your blood urate level doesn’t come down far enough for the crystals to dissolve.

Once your urate level is stable and in the target range, you’ll need yearly blood tests to check your urate levels remain the same.

Febuxostat is a long-term treatment. So, it’s important to keep taking it even:

• if it doesn’t seem to be working at first
• if you have more attacks of gout when you first start febuxostat
• when you stop having attacks of gout, otherwise urate levels may start to build up again and your symptoms may come back.

Your doctor will often advise you take something to prevent attacks of gout for the first six months after starting febuxostat, or after a dose increase. This will usually be a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen; colchicine or a low dose of steroids.

However, some drugs interact with febuxostat, so you should discuss any new medication with your doctor before starting it, and you should always tell anyone else treating you that you’re taking febuxostat.

The following drugs interact with febuxostat and generally should not be taken along with febuxostat:

• Azathioprine (Aza-thy-o-preen) — used to treat immune conditions, such as rheumatoid arthritis.
• Mercaptopurine (mer-kap-toh-pyoo-reen) — used to treat cancer and immune conditions.
• Didanosine (dy-da-no-seen) — sometimes used in the treatment of HIV.

The most common side effect of febuxostat is an increase in attacks of gout during the early stages of treatment. But If you do have an attack of gout, don’t stop taking febuxostat. Treat the attack as you would normally.

Most people do not experience other side effects. For those who do, they aren’t usually serious. However, if you have severe side effects, or are concerned about your symptoms, contact one of the healthcare professionals in charge of your care.

Some of the most common side effects can include:

• diarrhoea
• headaches
• skin rashes
• feeling sick (nausea)
• abnormal liver test results
• build-up of fluid, usually in lower legs and ankles.

If you develop a rash when you start febuxostat, swelling of the face or fever, particularly within the first month, you should seek medical advice immediately. You should also tell your doctor if you develop any new symptoms or there’s anything else that concerns you.

If you’re unable to continue taking febuxostat, and you’ve already tried allopurinol unsuccessfully, your doctor may suggest a drug such as benzbromarone or sulfinpyrazone. These drugs reduce urate levels by increasing the amount of urate passed in the urine.

You can have vaccinations while on febuxostat.

Alcohol doesn’t interact significantly with febuxostat, but it does increase the level of urate in the blood. Because of this, it can make you more susceptible to attacks of gout.

Government guidelines say both men and women should have no more than 14 units of alcohol a week. This is equivalent to about six glasses of wine or six pints of beer. You can find out more about units of alcohol at www.drinkaware.co.uk.

Your doctor might advise a lower limit as part of your general treatment plan to reduce your urate levels.

It’s not known what effect febuxostat can have on your baby, so you shouldn’t take it if you’re pregnant or breastfeeding.

If you’re planning a family or become pregnant while taking febuxostat you should discuss this with your doctor.

The effects of febuxostat on fertility are not currently known, but it’s unlikely to be harmful.