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Xanthine Oxidase Inhibitor — Urate-lowering Therapy

Febuxostat

Brand names: Adenuric

Used in: Gout

Febuxostat is a xanthine-oxidase inhibitor that lowers serum urate in the long-term management of gout, used as an alternative to allopurinol, particularly where allopurinol is not tolerated or is unsuitable.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Recommended dosage is 40 mg or 80 mg once daily. The recommended starting dosage is 40 mg once daily. For patients who do not achieve a serum uric acid (sUA) less than 6 mg/dL after 2 weeks, the recommended dosage is 80 mg once daily. ( 2.1 ) Patients with severe renal impairment: Limit the dosage to 40 mg once daily. ( 2.2 , 8.6 ) Flare prophylaxis is recommended upon initiation of febuxostat tablets. ( 2.4 ) Can be administered without regard to food or antacid use. ( 2.1 ) 2.1 Recommended Dosage The recommended febuxostat tablets dosage is 40 mg or 80 mg once daily. The recommended starting dosage of febuxostat tablets is 40 mg once daily. For patients who do not achieve a serum uric …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-05-08. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It inhibits xanthine oxidase, the enzyme that converts hypoxanthine and xanthine to uric acid, thereby reducing urate production and serum urate concentration.

Prescribing in practice

  • It must not be used with azathioprine or mercaptopurine, as inhibiting their metabolism causes dangerous accumulation and severe myelosuppression.
  • Starting treatment can precipitate acute gout flares, so co-prescribe flare prophylaxis when initiating and continue it for the recommended period.
  • Following an MHRA caution, avoid where possible in patients with significant pre-existing cardiovascular disease.

Monitoring

Monitor serum urate to confirm response, check liver function periodically as hepatic reactions can occur, and remain alert to cardiovascular symptoms in at-risk patients.

Counselling the patient

  • A gout flare may occur when starting; this does not mean the medicine is failing, and prophylaxis is given to reduce it.
  • Report a rash promptly, as serious skin reactions can rarely occur.
  • Do not take it with azathioprine or mercaptopurine; tell your prescriber if you are on either.

Evidence & guidelines

Recommended option for chronic hyperuricaemia in gout where allopurinol is unsuitable (NICE TA164; MHRA cardiovascular safety advice).

Reference: NICE NG219 (Gout); MHRA Febuxostat Safety Update 2019; FAST Trial (Lancet 2020); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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