Febuxostat (Uloric) is a medication that lowers the levels of uric acid in the body. It is used for the chronic management of gout. It blocks the active site on xanthine oxidase, preventing the conversion of hypoxanthine and xanthine to uric acid. This, in turn, decreases levels of uric acid in the blood and thus helps to prevent gout flares.
Febuxostat comes in pill form. It is recommended to start febuxostat at 40 mg daily. If patients are unable to achieve a goal serum uric acid level of <6 mg/dL (or <5mg/dL in some patients) after two weeks, the medication should be increased to 80 mg daily. Febuxostat should be started in conjunction with a medication to prevent gout flares, such as colchicine or NSAIDs. Febuxostat does not need to be taken with meals. For mild liver or kidney damage, the dosage does not need to be adjusted. There are no studies looking at this medication in patients with severe kidney or liver damage; thus, caution should be used when prescribing febuxostat in this patient population.
This medication should not be used in patients who are taking azathioprine or mercaptopurine, as these medications can increase the serum levels of febuxostat in your blood, leading to toxic side effects. Along with elevated liver enzymes, headache, joint pain, and rash can be side effects of this medication. Higher rates of heart attacks and strokes were noted in patients taking febuxostat compared to allopurinol.
More frequent gout attacks have also been noted in patients when starting febuxostat. If gout attacks occur while on febuxostat, these can be treated with NSAIDs or glucocortcoids but febuxostat should not be stopped.
If you notice chest pain, chest pressure, shortness of breath, weakness, or neurological deficits, tell your rheumatology provider immediately. Also inform them if you are taking any other medications which may interact with this drug, please tell your doctor. If you experience joint pain or rashes while on this medication, tell your rheumatology provider, as the medication dose may need to be adjusted.
Updated February 2022 by Kristen Lee, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.
This information provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.