Tab Febuxtat dose
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Febuxostat dose gout 2024 guidelines
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Febuxostat (Tab Febuxostat) - Complete Dosing Guide
Drug class: Non-purine selective xanthine oxidase (XO) inhibitor
Indication: Chronic hyperuricemia in gout (NOT for asymptomatic hyperuricemia)
Dosing
| Step | Dose | Timing |
|---|---|---|
| Initial | 40 mg once daily | With or without food |
| Uptitration | 80 mg once daily | If serum uric acid (sUA) remains >6 mg/dL after 2 weeks |
- FDA-approved doses: 40 mg and 80 mg only (120 mg used in some trials but not FDA-approved due to CV concerns)
- Target sUA: <6.0 mg/dL (360 µmol/L); for tophaceous gout, aim <5 mg/dL
Renal / Hepatic Impairment
- No dose adjustment needed for mild-to-moderate renal or hepatic impairment - febuxostat is primarily liver-metabolized
- Use with caution if eGFR <30 mL/min (limited data for severe renal impairment)
Pharmacokinetics
| Parameter | Value |
|---|---|
| Absorption | >80% oral bioavailability; Tmax ~1-1.5 h |
| Half-life | 4-8 hours (once-daily dosing effective) |
| Metabolism | Hepatic (UGT1A1, 1A3, 1A9, 2B7; CYP1A2, 2C8, 2C9) |
| Excretion | Hepatic + renal; <5% unchanged in urine |
Note: Antacids (Mg(OH)2, Al(OH)3) delay absorption ~1 h. Food slightly reduces absorption but is clinically insignificant.
Key Precautions
- Boxed Warning: Possible increased risk of cardiovascular death vs. allopurinol (though subsequent data have not confirmed this - CARES trial signal not replicated)
- Gout flares on initiation are common - co-prescribe colchicine or an NSAID prophylactically at the start of therapy
- Contraindicated with azathioprine or mercaptopurine (XO inhibition raises their toxic metabolite levels - risk of life-threatening bone marrow suppression)
- Monitor liver function tests periodically
Place in Therapy
- Second-line after allopurinol (allopurinol is preferred as first-line)
- Good choice when: allopurinol is not tolerated / prior hypersensitivity / insufficient dose escalation due to renal impairment
- 40 mg febuxostat ~ 300 mg allopurinol in urate lowering; 80 mg febuxostat > 300 mg allopurinol
Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics; Katzung's Basic and Clinical Pharmacology 16th Ed; Comprehensive Clinical Nephrology 7th Ed
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