(feb UX oh stat)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Uloric: 40 mg, 80 mg
Brand Names: U.S.
- Antigout Agent
- Xanthine Oxidase Inhibitor
Selectively inhibits xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid thereby decreasing uric acid. At therapeutic concentration does not inhibit other enzymes involved in purine and pyrimidine synthesis.
Vss: ~50 L
Extensive conjugation via uridine diphosphate glucuronosyltransferases (UGTs) 1A1, 1A3, 1A9, and 2B7 and oxidation via cytochrome P450 (CYP) 1A2, 2C8, and 2C9 as well as non-P450 enzymes. Oxidation leads to formation of active metabolites (67M-1, 67M-2, 67M-4)
Urine (~49% mostly as metabolites, 3% as unchanged drug); feces (~45% mostly as metabolites, 12% as unchanged drug)
Time to Peak
Plasma: 1 to 1.5 hours
~5 to 8 hours
~99%, primarily to albumin
Special Populations: Gender
Following multiple oral doses, Cmax and AUC are 30% and 14% higher in women than men, respectively.
Use: Labeled Indications
Hyperuricemia: Chronic management of hyperuricemia in patients with gout.
Limitations of use: Not recommended for treatment of asymptomatic hyperuricemia.
Concurrent use with azathioprine or mercaptopurine
Canadian labeling: Additional contraindications (not in U.S. labeling): Hypersensitivity to febuxostat or any component of the formulation.
Note: It is recommended to take an NSAID or colchicine with initiation of therapy and may continue for up to 6 months to help prevent gout flares. If a gout flare occurs, febuxostat does not need to be discontinued.
U.S. labeling: Initial: 40 mg once daily; may increase to 80 mg once daily in patients who do not achieve a serum uric acid level <6 mg/dL after 2 weeks. The dose may be increased further to 120 mg once daily if clinically indicated (ACR guidelines [Khanna, 2012]).
Canadian labeling: 80 mg once daily
Refer to adult dosing.
Dosing: Renal Impairment
Mild to moderate impairment (CrCl 30 to 89 mL/minute): No dosage adjustment necessary
Severe impairment (CrCl <30 mL/minute):
US labeling: There are no dosage adjustments provided in the manufacturer’s labeling (insufficient data); use caution.
Canadian labeling: Use is not recommended (insufficient data).
US labeling: There are no dosage adjustments provided in the manufacturer’s labeling; has not been studied.
Canadian labeling: Use is not recommended (insufficient data).
Dosing: Hepatic Impairment
Mild to moderate impairment (Child-Pugh class A or B): No dosage adjustment necessary
Severe impairment (Child-Pugh class C):
US labeling: There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use caution.
Canadian labeling: Use is not recommended (has not been studied)
Oral: Administer with or without meals or antacids.
Take with or without meals or antacids.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light.
AzaTHIOprine: Febuxostat may increase the serum concentration of AzaTHIOprine. Avoid combination
Didanosine: Febuxostat may increase the serum concentration of Didanosine. Avoid combination
Mercaptopurine: Febuxostat may increase the serum concentration of Mercaptopurine. Avoid combination
Pegloticase: Febuxostat may enhance the adverse/toxic effect of Pegloticase. Specifically, Febuxostat may blunt increases in serum urate that would signal an elevated risk of anaphylaxis and infusion reactions. Avoid combination
Theophylline Derivatives: Febuxostat may increase serum concentrations of the active metabolite(s) of Theophylline Derivatives. Specifically, concentrations of 1-methylxanthine, a metabolite of unknown clinical importance, may become elevated. Exceptions: Dyphylline. Monitor therapy
1% to 10%:
Dermatologic: Rash (1% to 2%)
Gastrointestinal: Nausea (1%)
Hepatic: Liver function abnormalities (5% to 7%)
Neuromuscular & skeletal: Arthralgia (1%)
<1% (Limited to important or life-threatening): Abnormal electroencephalogram, abnormal gait, aggressive behavior, agitation, alopecia, anaphylaxis, anaphylaxis, anemia, angina pectoris, angioedema, anorexia, anxiety, arthralgia, atrial fibrillation, atrial flutter, blurred vision, bruise, cardiac failure, cerebral infarction, cerebrovascular accident, cerebrovascular accident, cholecystitis, cholelithiasis, constipation, deafness, decreased hematocrit, decreased libido, decreased serum bicarbonate, decreased urine output, dehydration, depression, dermatitis, diabetes mellitus, DRESS syndrome, dysgeusia, dyspepsia, dyspnea, ECG abnormality, eczema, edema, epistaxis, erectile dysfunction, flu-like symptoms, flushing, gastritis, gastroesophageal reflux disease, gingival pain, Guillain-Barré syndrome, gynecomastia, hair discoloration, heart murmur, hematemesis, hematochezia, hematuria, hemiparesis, hepatic failure, hepatitis, hepatomegaly, herpes zoster, hirsutism, hot flash, hyperacidity, hypercholesterolemia, hyperglycemia, hyperhidrosis, hyperkalemia, hyperlipidemia, hypernatremia, hypersensitivity, hypertension, hypertriglyceridemia, hypokalemia, hypotension, immune thrombocytopenia, increased amylase, increased blood urea nitrogen, increased creatine phosphokinase, increased lactate dehydrogenase, increased MCV, increased serum alkaline phosphatase, increased serum creatinine, increased thyroid stimulating hormone level, increased urine output, interstitial nephritis, jaundice, joint swelling, lethargy, leukocytosis, leukopenia, liver steatosis, lymphocytopenia, migraine, muscle spasm, muscle twitching, myalgia, myocardial infarction, nephrolithiasis, neutropenia, oral mucosa ulcer, pain, palpitations, pancreatitis, pancytopenia, panic attack, paresthesia, peptic ulcer, personality changes, petechia, pharyngeal edema, pollakiuria, prolonged partial thromboplastin time, prolonged prothrombin time, prostate specific antigen increase, proteinuria, psychotic symptoms, renal failure, respiratory tract infection, rhabdomyolysis, sinus bradycardia, skin discoloration, skin photosensitivity, splenomegaly, Stevens-Johnson syndrome, tachycardia, thrombocytopenia, tinnitus, toxic epidermal necrolysis, transient ischemic attacks, tremor, urinary incontinence, urinary tract infection, urticaria, vertigo, vomiting, weakness, weight gain, weight loss
Concerns related to adverse effects:
• Hepatic failure: Postmarketing cases of hepatic failure (both fatal and nonfatal) have been reported (causal relationship has not been established). In controlled studies, significant hepatic transaminase elevations (>3 x ULN) have occurred (causal relationship not established). Liver function tests should be evaluated at baseline and periodically thereafter; evaluate liver function tests promptly in patients experiencing signs and symptoms of hepatic injury (eg, fatigue, anorexia, right upper quadrant pain, dark urine, jaundice). Interrupt therapy in patients who develop abnormal liver function tests (eg, ALT >3 x ULN); permanently discontinue use if no other explanation for the abnormalities is elucidated and in patients who develop ALT >3 x ULT and serum total bilirubin >2 x ULN. All other patients may be cautiously restarted on febuxostat.
• Hypersensitivity: Hypersensitivity and serious skin reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS) have been reported, particularly in patients with prior skin reactions to allopurinol; use with caution if a patient has a history of hypersensitivity reaction to allopurinol.
• Thromboembolic events: MI, stroke and cardiovascular deaths were reported at a slightly increased rate versus allopurinol in controlled studies (a causal relationship has not been established). Patients should be monitored for signs and symptoms of MI or stroke. The Canadian labeling recommends avoiding use in patients with ischemic heart disease or heart failure.
• Hepatic impairment: Use with caution in patients with severe hepatic impairment (Child-Pugh class C); has not been studied. Canadian labeling recommends avoiding use in severe impairment.
• Renal impairment: Use with caution in patients with severe renal impairment (CrCl <30 mL/minute); insufficient data. Canadian labeling recommends avoiding use in severe impairment or end-stage renal disease (ESRD) requiring dialysis.
• Secondary hyperuricemia: Use in secondary hyperuricemia has not been studied; avoid use in patients at increased risk of urate formation (eg, malignancy and its treatment; Lesch-Nyhan syndrome).
Dosage forms specific issues:
• Lactose: Contains lactose; Canadian labeling recommends avoiding use in patients with hereditary conditions of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption.
• Appropriate use: Administer concurrently with an NSAID or colchicine (up to 6 months) to prevent gout flare, which may occur upon initiation of therapy. Do not use to treat asymptomatic or secondary hyperuricemia.
Liver function tests at baseline and then periodically, serum uric acid levels (as early as 2 weeks after initiation); signs/symptoms of MI or stroke, signs/symptoms of hypersensitivity or severe skin reactions
Pregnancy Risk Factor
Animal studies have demonstrated increased neonatal mortality and reduction in weight gain, but not teratogenic effects. The Canadian labeling recommends avoiding use in pregnant women.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience joint pain. Have patient report immediately to prescriber signs of bleeding (vomiting blood or vomit that looks like coffee grounds, coughing up blood, blood in the urine, black, red, or tarry stools, bleeding from the gums, abnormal vaginal bleeding, bruises without a reason or that get bigger, or any bleeding that is very bad or that will not stop), signs of severe cerebrovascular disease (change in strength on one side is greater than the other, trouble speaking or thinking, change in balance, or change in eyesight), signs of liver problems (dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes), angina, painful urination, severe loss of strength and energy, severe dizziness, passing out, severe headache, severe nausea, severe vomiting, , sweating a lot, urinary retention, change in amount of urine passed, tachycardia, bradycardia, arrhythmia, chills, pharyngitis, hearing impairment, mood changes, muscle pain, muscle weakness or shortness of breath (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
More about febuxostat
- Other brands: Uloric