Febuxostat

• In order for febuxostat to work effectively, it should be continued even when the symptoms of gout resolve. If it is stopped, gout flares and other gout symptoms may return.
• You should also continue to take febuxostat during a gout flare.

Febuxostat is taken on a long-term basis to prevent gout flares and tophi. Taking febuxostat regularly each day will also help to prevent permanent damage to the joints. It does not treat the pain or inflammation of a gout flare. Febuxostat does not work straight away; t may take weeks to months to reduce the level of urate in your blood to the target concentration, so you could continue to have gout flares until all the crystals are dissolved.  

Starting febuxostat or increasing the dose can sometimes y cause a gout flare. This does not mean the medicine is not working and febuxostat should be continued during the flare. Your doctor will advise you on the appropriate medicines to treat the flare itself.

Your doctor may also recommend a medicine to prevent flares during the first 6-12 months of treatment with febuxostat.

Febuxostat is not a pain reliever. You should continue to take febuxostat during a gout flare, but your doctor will also recommend medicines to treat pain and inflammation. These may include colchicine, anti-inflammatory medicines such as naproxen, ibuprofen, indomethacin or steroids such as prednisolone. The choice of medicine will depend on your existing medicines and medical conditions.
It is a good idea to plan with your doctor what to do if a gout flare occurs.

Febuxostat is taken by mouth as a tablet, usually once a day. You should take your febuxostat at the same time each day. 
It does not matter if you take febuxostat before or after food. It should be taken with a full glass of water. 
Febuxostat should be taken regularly. If you forget to take a dose, restart the next day as you would normally. There is no need to double the dose at the next scheduled dose time.

What is the dosage?

Febuxostat tablets are available in one strength of 80mg. Treatment may start at 40mg (half a tablet) once a day. Over time your doctor may increase your dose to 80mg (one tablet) daily. The maximum is 120mg (one and one-half tablet) daily.

Can other medications be taken with febuxostat?

Febuxostat may be taken in combination with other arthritis medicines, including:
•    steroid medicines such as prednisolone or cortisone injections into the joint
•    anti-inflammatory medicines (NSAIDs) such as naproxen or ibuprofen
•    colchicine (Colgout)
•    pain-relieving medicines such as paracetamol.
It is important that febuxostat is not taken together with other gout medicines including allopurinol and azathioprine.
Other medicines that may interfere with febuxostat include mercaptopurine theophylline, rosiglitazone and phenytoin.

How long is the treatment continued?

If there are no side-effects, febuxostat should be taken long term.
Even if all your gout flares and tophi resolve, febuxostat should be continued; stopping it will eventually lead to these symptoms returning.

Most people do not experience side effects from febuxostat. Tell your doctor if you are concerned about any possible side effects.

Most common possible side effects

• The most common side effects are headache and dizziness, nausea or diarrhoea, rash and itching. They are usually mild and only last for a short time. Febuxostat may also cause an increase in gout symptoms in the first few months. Your doctor will plan your gout treatment to help prevent this.

Less common or rare possible side effects

• If you ever experience serious side effects such as chest pain, difficulty breathing, loss of consciousness or stroke symptoms, seek immediate medical attention.
• Skin problems: Febuxostat can cause a skin rash. Very rarely, an allergic reaction to febuxostat can occur. Signs of an allergic reaction include a severe skin rash with itching or hives, swelling of the face, lips, tongue or other parts of the body, and shortness of breath or trouble breathing. Mouth ulceration can also occur.
• Liver: Febuxostat can cause changes to liver function. Your doctor may do blood tests to check if this occurs. The dose of febuxostat may need to be reduced or it may need to be stopped if problems occur. Contact your doctor immediately if you notice yellowing of the skin and/or whites of the eyes. 
• Other side effects not listed here may occur in some people. 

Long term side effects

Long term use is not associated with an increase in the risk of death or serious events when compared with similar medicine such as allopurinol.

Blood tests

• The serum urate level in your blood will be checked to make sure the medicine is working.  
• It is important to see your general practitioner (GP) regularly as they have an important role in monitoring your condition.

Use with other medicines

• Febuxostat can interact with some other medicines. You should tell all of your doctors about all medicines you are taking or plan to take. This includes medicines that you buy without a prescription from your pharmacy, supermarket or health food shop. You should also mention your treatment when you see other health professionals.

Use with alcohol

• Febuxostat does not interact with alcohol. However, excessive alcohol consumption is a risk factor for gout. 

Use in pregnancy and when breastfeeding

• You should not take febuxostat if you are pregnant. It is not known whether febuxostat causes birth defects.
• If you are pregnant or are considering having a child, you should discuss this with your doctor before starting this medicine.
• You should not breastfeed if you are taking febuxostat. It is not known if febuxostat passes into breastmilk. 

• Store your febuxostat tablets in a cool, dry place, away from direct heat and light. 
• Keep all medicines out of reach of children.