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Gout in CKD

Febuxostat (CKD)

Brand names: Adenuric

Febuxostat in chronic kidney disease (CKD) is a non-purine xanthine oxidase inhibitor used for chronic gout where allopurinol is unsuitable, and is often favoured in renal impairment as it is predominantly metabolised by the liver.

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.

Clinical monograph

How it works

It selectively inhibits xanthine oxidase, blocking conversion of hypoxanthine and xanthine to uric acid and thereby lowering serum urate.

Prescribing in practice

  • Use with caution in significant cardiovascular disease, as an MHRA review highlighted a possible increased risk of cardiovascular death compared with allopurinol in patients with pre-existing major cardiac disease.
  • Hepatic metabolism makes dose adjustment less critical in mild-to-moderate renal impairment than for allopurinol, but caution and SPC checks apply in severe impairment.
  • Co-prescribe gout flare prophylaxis when starting, since urate-lowering can precipitate acute attacks.

Monitoring

Monitor serum urate to target and check liver function tests, particularly in the early months of treatment.

Counselling the patient

  • An increase in gout flares when first starting is common and does not mean the drug is failing.
  • Report chest pain, breathlessness or symptoms of stroke promptly if you have heart disease.
  • Continue taking it long term and do not stop during a flare.

Evidence & guidelines

The CARES trial and a subsequent MHRA safety review informed cardiovascular cautions in patients with established heart disease.

Reference: FAST Trial (Wilson et al. Lancet 2020); MHRA DSU 2019 (CV Risk); NICE CG56 (Gout); SPC Adenuric; 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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