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Treatment
Febuxostat: the newer uric acid drug — when to use instead of allopurinol and the heart warning
Stronger and less allergenic than allopurinol, but carries a cardiovascular warning.
Febuxostat is a selective xanthine oxidase inhibitor: 40–80 mg roughly equals allopurinol 300–600 mg.
When chosen
- Allopurinol allergy or HLA-B*5801
- Allopurinol 600–800 mg still not at target
- Moderate kidney disease
- Large tophi
Heart warning
CARES (2018) found higher cardiovascular death vs allopurinol in people with existing heart disease; FAST (2020) did not. Practical rule: prefer allopurinol if you have serious heart disease.
Use
- Start 40 mg; raise to 80 mg after 2–4 weeks if above 360
- Any time of day
- Colchicine prophylaxis 3–6 months
Products mentioned
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Informational only; not a substitute for a doctor's diagnosis and prescription.