Febuxostat and Gout

Gout and Febuxostat

Febuxostat: The New Kid on the Block

Febuxostat is a pharmaceutical drug first discovered by Japanese scientists in 1998, that goes by the trade name Uloric in the US and Adenuric in Europe. Febuxostat first came to market in Europe in 2008 and Takeda Pharmaceutical obtained FDA approval for the US in 2009. It is a drug that inhibits xanthine oxidase, effectively reducing uric acid in the body. Like allopurinol, it is used to treat chronic gout and hyperuricemia.

Recent research suggests that febuxostat is more effective compared to allopurinol in the treatment of gout. According to the authors of a study published in Arthritis Research & Therapy Comparative effectiveness of urate lowering with febuxostat versus allopurinol in gout: analyses from large U.S. managed care cohort, optimal treatment of gout is based on two principles: adequate chronic use of urate-lowering therapies and aiming to achieve target serum urate (sUA) levels and anti-inflammatory therapies for acute flares and anti-inflammatory prophylaxis.” Note that until 2009 since the FDA approved Febuxostat, the only drug utilized for this purpose was allopurinol.

The researchers conducted a retrospective study of medical and pharmacy claims and laboratory data from a large US commercial and commercial insurance health plan claims data for a 3 year period between 2009 to 2011. The purpose of this was “to study the change in sUA with allopurinol versus febuxostat treatment by assessing the proportion of patients achieving a post-index sUA goal of <6.0 mg/dL in the follow-up period, a clinically meaningful and important outcome for patients with gout.

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In conclusion, the researchers found that more febuxostat users reached uric acid target levels, and this happened more quickly than with allopurinol. Up until now febuxostat is recommended as a second-line drug for people who cannot use allopurinol cause it causes side effects for them. And for gout sufferers who also suffer from renal disease and very high uric acid levels, febuxostat is more effective in regularizing uric acid levels. Research continues to be conducted into the long term effects of febuxostat around the world. I will keep you posted as new information arises. Make sure to subscribe to my Facebook, Twitter and Google Plus accounts, where I report my gout news updates.

How To Take Febuxostat

Febuxostat is taken in tablet form with water, once daily with or without food. Febuxostat is available in 80 mg and 120 mg strength tablets. Your doctor will usually start you at 80 mg daily and only increase it to 120 mg if you haven’t reached targeted uric acid levels. Febuxostat usually lowers uric acid levels within a few weeks time.

The side effects associated with febuxostat include nausea, diarrhea, arthralgia, headache, increased hepatic serum enzyme levels and rash. For those wanting to learn more about febuxostat, I’ve linked to this extensive Medscape article for you to review. If you are on febuxostat, I’d like to hear from you. Leave a comment below!

Posted by Spiro Koulouris

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  • Donald

    Reply Reply May 17, 2016

    I have been on Febuxostat for a month and a half and am in the midst of a 2 week gout attack. Prior to taking the medication, my uric acid was 8- 10 mg/dL and I had (have) TOPHI on my big toe. I have a uric acid meter at home that shows uric acid level in my blood is now below 3 mg/dL. Can you tell me why I am getting a gout attack? I thought they only occurred when uric acid was high. I am confused. Thank you.

    • Spiro Koulouris

      Reply Reply May 18, 2016

      Good question Donald!

      You can get a gout attack if there is a wild swing in your uric acid level, which seems to be the case here but don’t take my word for it, check it out with your doctor. For example, many gout sufferers will get a gout attack when losing weight too quickly but if you suffer from tophi, that means your gout is on the extreme range. I hope you feel better Donald soon!

  • Binu P

    Reply Reply December 28, 2015

    I started Febuxostat 80mg only 4 days back supplemented for the next 3 months with Colchicine twice daily.

    I was suffering from gout when I started it, but my gout flare up over the last 2-3 years had become more frequent to almost once in a week or two. It has always been on the feet and most often on around toe joints. Colchicine with NSAID for 3 days after onset would clear it but was told that it is important to be proactive and prevent it with a continuous dose of the Febuxostat. Creatinine levels were checked. Have to wait and see over the next couple of weeks to know if the gout attacks happen, especially after resume 3 times a week yoga.

    Does anyone know if there is one and what is the nature of
    link between border line high HBA1C and Uric acid, which has been 350-375 the last couple of time it was tested over the years.

    I am within healthy weight range, have always eaten ‘healthy’ and been ‘active’, but the HBA1C has not gotten a lot better, but was told it may be linked to gout attacks. From now on I will controlling my dessert intake to see if it helps when blood test is repeated in 3 months. I am not so much willing to make big dietary changes that would impact the family dynamics. Also hope Creatinine kidney function does not change much due to Febuxostat.

    Any further insight into my diagnosis and managing of gout attacks would help my initiative to find a long term plan.

  • Ayman

    Reply Reply December 28, 2015

    One of the gout side effects that I have started to face recently is that even a small walk will cause pain in my foot just behind the big toe where the flare usually attacks, I am searching for a shoes or a special insole that I can use to decrease the pressure on my big toe as maybe this will help in reducing the pain, anyone got an idea on what to use and from where can I get it online please?

    • Spiro Koulouris

      Reply Reply December 28, 2015

      Hi Ayman!

      A podiatrist should be able to guide to a custom made shoe insole for your feet!

  • Liam F.

    Reply Reply December 28, 2015

    For me the flare ups stopped after about 3m. I was on a side dose of colcihine for a few months to help treat the flare ups

  • Liam F.

    Reply Reply December 28, 2015

    The drug causes uric acid levels to decrease. In the first 3months or so it will cause uric to leach from your tissue, were it has been stored, when level was too high. This can cause gout flare ups. This will pass, as uric acid in tissue excreted. Probably best to persevere. Maybe see your doctor about a prophylaxis drug to treat flare ups your getting? Hope things improve Reese

  • Reese Railey

    Reply Reply December 28, 2015

    Liam,I have been taking this for two months but it seems not working for me. The pain just transfers from one side to another. I can no longer work because of this. For How long did you take this and when did the pain and inflammation finally surpass?

  • Reese Railey

    Reply Reply December 28, 2015

    Hi. Can i ask question.. Im with suffering gout. Almost 2mos it attacks on different body parts after each attack it transfers from one side to another.. Im taking febuxostat for 2mons. Yet nothing happen.. And im also taking diet program. Wat should i do?? Can i take steroids so i could get back to work??

    • Spiro Koulouris

      Reply Reply December 28, 2015

      Follow your doctor’s advice, I don’t know enough about your health situation to provide you with any recommendations. Ask your doctor about steroids, it helps short term to remove the pain so you can be functional.

  • Chris

    Reply Reply December 17, 2015

    Would you know if Febuxostat is available in South Africa? I had taken puricos (allopurinol) for 8 months with no success.

    • Spiro Koulouris

      Reply Reply December 17, 2015

      Chris I wish I could help you but I don’t know why Febuxostat isn’t available there, best to contact the drug maker directly and ask if it’s available anywhere in South Africa. If allopurinol didn’t work, then you must inquire about Febuxostat and eat very healthy, follow my gout dietary tips.

  • Liam F.

    Reply Reply December 12, 2015

    I take this. Very thankful for this drug; I coudn’t tolerate allopurinol. I’ve had no gout flare ups once through the initial three months of use of Febuxostat. Uric acid levels now normal.

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