Febuxostat
1 medicine
Febuxostat lowers uric acid to prevent gout attacks, but it carries a boxed warning for a higher risk of cardiovascular death than allopurinol, especially in people with existing heart disease.
Key facts
- Febuxostat is a xanthine oxidase inhibitor that lowers uric acid to prevent gout attacks. It does not relieve pain during an acute flare.
- You take it once daily, and it can take several weeks of steady use before uric acid levels settle and flares become less frequent.
- Febuxostat carries a boxed warning: in a large trial it caused more cardiovascular deaths than allopurinol, particularly in people with existing heart disease.
- Seek urgent care for chest pain, sudden shortness of breath, or signs of a stroke.
What febuxostat treats
Febuxostat treats chronic hyperuricemia in people with gout, lowering uric acid so crystals stop forming in joints over time. It's generally used when allopurinol hasn't worked well enough or can't be tolerated. It is not used for an acute gout flare, and gout attacks can actually increase in the first months of treatment as stored urate crystals are mobilized.
How febuxostat works
Uric acid is made in the liver when an enzyme called xanthine oxidase breaks down purines from food and cell turnover. Febuxostat blocks this enzyme, so less uric acid is produced and blood levels fall. Over months, this lets existing urate crystals in joints gradually dissolve, reducing how often gout flares occur.
Before you take it
- Tell your doctor about any heart disease, including a previous heart attack, stroke or heart failure; febuxostat may not be the right choice given its cardiovascular risk.
- Do not take febuxostat with azathioprine or mercaptopurine. Blocking xanthine oxidase raises these drugs to toxic levels.
- Mention liver disease, since febuxostat is processed by the liver and enzyme levels are usually checked before starting.
- A short course of an anti-inflammatory medicine is often started alongside febuxostat to reduce flares in the first weeks.
Side effects
Common effects include nausea, joint pain, rash and mild liver enzyme changes picked up on blood tests.
Stop and seek urgent medical care for any of these:
- Chest pain, irregular heartbeat, or sudden shortness of breath.
- A severe skin reaction: spreading rash, blistering, or peeling skin.
- Yellowing of the skin or eyes, or dark urine.
Safety essentials
- Discuss your cardiovascular history before starting. Febuxostat is generally avoided if you already have heart disease and a suitable alternative exists.
- Never combine febuxostat with azathioprine or mercaptopurine.
- Expect more frequent gout flares for the first weeks of treatment. Keep taking febuxostat as directed and treat flares separately, since stopping early prevents uric acid from ever coming down.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.