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Febuxostat Dosage

Medically reviewed on April 24, 2018.

Applies to the following strengths: 80 mg; 40 mg

Usual Adult Dose for Gout

Initial dose: 40 mg orally once a day
-If serum uric acid level is greater than 6 mg/dL after 2 weeks, increase the dose to 80 mg orally once a day
Maintenance dose: 40 to 80 mg orally once a day

Comments:
-Use of this drug should occur after an acute gout flare subsides.
-Gout flares may occur due to increased urate mobilization from tissue deposits, especially during initiation; gout flare prophylaxis with a non-steroidal anti-inflammatory or colchicine is recommended and may be beneficial for up to 6 months.
-Uric acid levels may be checked as soon as 2 weeks after beginning this drug.

Use: Chronic management of symptomatic hyperuricemia in patients with gout

Renal Dose Adjustments

Mild to Moderate Renal Dysfunction (CrCl 30 to 89 mL/min) No adjustment recommended
Severe Renal Dysfunction (CrCl 15 to 29 mL/min): Maximum daily dose should be limited to 40 mg/day

Liver Dose Adjustments

Mild to Moderate Liver Dysfunction (Child-Pugh Class A and B): No adjustment recommended.
Severe Liver Dysfunction (Child-Pugh Class C): Use with caution.

-For patients who develop ALT levels greater than 3 times the upper limit of normal (3 x ULN): Interrupt treatment; do not restart without another explanation for ALT abnormalities.
-For patients who develop ALT levels greater than 3 x ULN AND bilirubin greater than 2 x ULN: Therapy should be discontinued and not restarted in patients without alternative etiologies.
-For patients with lesser ALT or bilirubin elevations AND with an alternate probable cause: Use with caution.

Dose Adjustments

Gout:
-Therapeutic target is to decrease and maintain serum uric acid levels below 6 mg/dL.
-If a patient does not achieve a serum uric acid level of less than 6 mg/dL after 2 to 4 weeks, a dose increase is warranted.
-Maximum dose: 80 mg/day

Concomitant use with mercaptopurine/azathioprine is contraindicated.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-May be taken with or without food.
-This drug may be taken without regard to antacid use.

Storage requirements:
-Protect from light.

General:
-This drug should not be used to treat asymptomatic hyperuricemia.
-This drug should not be started until an acute gout flare has subsided.
-If gout flares occur during treatment, manage concurrently; discontinuation of this drug should not be necessary.

Monitoring:
-Liver test should be obtained at baseline and periodically thereafter; liver tests should be conducted in patients reporting signs/symptoms of liver injury (e.g., fatigue, anemia, upper right abdominal discomfort, dark urine, jaundice).
-Monitor for signs and symptoms of myocardial infarction and stroke.
-Serum uric acid may be measured as soon as 2 weeks after starting this drug.

Patient advice:
-Patients should speak with a healthcare provider before starting any new medications, including over the counter medications.
-Patients should be instructed to report skin or hypersensitivity reactions including rash, blistering, chest pain, shortness of breath, or neurological symptoms suggesting a stroke.
-Instruct patients to report signs/symptoms of liver injury to the health care provider.
-Inform patients that gout flares may occur, and they should not stop taking this drug if a gout flare occurs.
-Patients should be advised to speak to their healthcare provider if they are pregnant, intend to become pregnant, or are breastfeeding.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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