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Febuxostat

Sounds like 'feb-ux-oh-stat'

Key points about febuxostat

Febuxostat is a long-term treatment to prevent gout attacks.
When taken every day, febuxostat stops gout attacks and prevents long-term damage to your joints.
Find out how to take it safely and possible side effects.

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Febuxostat is used to prevent gout attacks or flares. It helps to prevent permanent damage to your joints. Febuxostat is used when other medicines like allopurinol cannot be taken or haven’t worked well. Febuxostat may be used in people receiving cancer chemotherapy(external link), to prevent high uric acid that can occur with some types of chemotherapy.

Febuxostat reduces the amount of uric acid your body makes. Uric acid is produced in your body when you digest and metabolise some types of food and drinks.
Usually excess uric acid is passed out in urine, but when uric acid levels are too high, the extra uric acid can turn into crystals in your joints, causing pain and swelling. This is known as gout.
With each new attack, the size and number of crystals grow and can sometimes be seen as lumps under the skin (tophi). Over time this can damage your joints, bones and kidneys.

To reduce gout attacks, it's important to keep your uric acid level below 0.36 mmol/L

When your uric acid is below 0.36 mmol/L, no new crystals can form and crystals that are already in your joints can start to dissolve.
The risk of gout attacks and joint damage is reduced.
If you already have tophi, the goal is to get to a uric acid level below 0.3 mmol/L.
Uric acid levels can be checked with a blood test, which can be done at a blood lab, at your doctors clinic or at some pharmacies.

In Aotearoa New Zealand febuxostat is available as 80 mg and 120 mg tablets.

To prevent gout attacks, the usual dose of febuxostat is 80 mg once daily.
After 2 to 4 weeks of treatment, your doctor will test your serum urate with a blood test. If it is still above 0.36 mmol/L, your dose may increase to 120 mg once daily.
Always take your febuxostat exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much febuxostat to take, how often to take it and any special instructions.

Timing: Take febuxostat, once a day, at about the same time each day. It's best taken in the morning. You can take febuxostat with or without food. Take your dose with a full glass of water.
Missed dose: If you forget to take your tablet, take it as soon as you remember. But if it is nearly time for your next tablet, just take the next tablet at the right time. Do not take double the dose.
Keep taking febuxostat every day, even during a gout attack: If you stop taking it, even for a few days, your uric acid levels will rise and crystals will start to form. This can cause a gout attack and joint damage. Febuxostat is a long-term medicine – you'll probably need to take it for the rest of your life.

You may have gout attacks when starting febuxostat

You may have gout attacks in the first few months as you're increasing your dose of febuxostat. If this happens, it may feel like your gout is getting worse, but it’s not. As febuxostat reduces the amount of uric acid your body makes, some of the crystals in your joints dissolve. As the crystals dissolve, they can cause a gout attack.

To manage this, when you start febuxostat, your doctor will prescribe preventative medication such as colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) or prednisone. It's important to take this regularly, for up to 6 months, while you are starting febuxostat.
Keep taking febuxostat every day, even during a gout attack.
As your uric acid level decreases over time you're less likely to get gout flares.
Keeping your uric acid level below 0.36 mmol/L, will help stop your gout attacks. This may take a few months of taking febuxostat every day.

Credits:RheumInfo(external link), 2019

Note: this video is from Canada so may have information that differs from New Zealand recommendations. In New Zealand febuxostat is also called Adenuric. Read more about febuxostat.

Here are some things to know when you're taking febuxostat. Other things may be important as well, so ask your healthcare provider what you should know about.

Other medicines: Febuxostat may interact with other some other medicines, herbal supplements and Rongoā Māori, so check with your doctor or pharmacist before starting febuxostat and before starting any new products.
If I'm having a gout attack, will an extra dose of febuxostat help? No. febuxostat is not a pain relief medicine. If you have an attack of gout while taking febuxostat, keep taking it at the same dose. Don't stop taking it. Your doctor will advise you to take a pain relief medicine, eg, NSAIDs (ibuprofen, diclofenac, naproxen), or prednisone or colchicine. You can also apply ice-packs and rest the painful joint to reduce pain. See your doctor if the pain and inflammation doesn't get better in 24 hours.

Like all medicines, febuxostat can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects	What should I do?
Headache Feeling sick or vomiting Diarrhoea (runny poo)	These are quite common when you first start taking febuxostat and usually go away with time. Tell your doctor if these side effects cause you problems or don’t go away.
Dizziness Sleepiness Blurred vision	Be careful when driving or using tools until you know how this medicine affects you
Signs of an allergic reaction, such as sudden redness of your skin, skin rashes, itching, swelling of your face, lips or mouth, and problems breathing, such as shortness of breath or wheezing	Stop taking febuxostat. Tell your doctor immediately or phone Healthline on 0800 611 116.
Signs of problems with your liver such as yellowing of your skin or eyes, dark pee or pain in your abdomen (tummy)	Tell your doctor immediately or phone Healthline on 0800 611 116.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product(external link)