Febuxostat (Rheumatology — Gout)

How it works

It is a selective non-purine inhibitor of xanthine oxidase, reducing the conversion of hypoxanthine and xanthine to uric acid and thereby lowering serum urate.

Prescribing in practice

• Febuxostat is associated with an increased risk of cardiovascular events and should be avoided in patients with major pre-existing cardiovascular disease (MHRA advice); review cardiovascular status before and during treatment.
• Serious hypersensitivity reactions, including rare cutaneous reactions such as Stevens-Johnson syndrome, can occur—stop the drug if a rash develops.
• Gout flares are common when starting; provide flare prophylaxis (e.g. colchicine or an NSAID) and do not stop febuxostat during an acute attack.

Monitoring

Monitor serum urate to confirm target lowering, liver function periodically, and remain alert for cardiovascular symptoms and hypersensitivity reactions.

Counselling the patient

• Keep taking it during a gout attack—it is a preventive treatment, not a painkiller.
• Expect possible flares early in treatment; take the prophylactic medicine as advised.
• Stop and seek advice immediately if you develop a skin rash, and report chest pain or breathlessness.

Evidence & guidelines

Febuxostat is established for chronic gout, with its urate-lowering efficacy and cardiovascular safety signal documented in randomised trials, MHRA advice and NICE gout guidance.