Febuxostat

About Febuxostat

Febuxostat is a xanthine oxidase inhibitor: it blocks the enzyme the body uses to make uric acid, so blood uric acid falls. The label approves it for the chronic management of hyperuricemia in adults with gout, and it is not recommended for high uric acid without gout symptoms (asymptomatic hyperuricemia). The usual start is 40 mg once a day; if the serum uric acid is not below 6 mg/dL after two weeks, the dose can be raised to 80 mg once a day. In severe kidney impairment the dose is limited to 40 mg once a day, and no adjustment is needed for mild to moderate kidney or liver impairment.

The boxed warning says gout patients with established cardiovascular disease who took Uloric had a higher rate of cardiovascular death than those on allopurinol. For that reason the label restricts use to patients who had an inadequate response to a maximally titrated dose of allopurinol, who cannot tolerate allopurinol, or for whom allopurinol is not advisable. It must not be taken with azathioprine or mercaptopurine, because febuxostat raises their levels and can cause toxicity. Fatal and nonfatal liver failure has been reported, and serious skin reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS have occurred, many in people who had reacted the same way to allopurinol. The most common side effects are abnormal liver tests, nausea, joint pain and rash.

Gout flares often increase in the first months after starting. The label recommends flare prophylaxis with an NSAID or colchicine when treatment begins, which may help for up to six months, and says a flare is not a reason to stop the tablet. A liver panel (ALT, AST, alkaline phosphatase and total bilirubin) is drawn before starting and repeated promptly if symptoms of liver injury appear; if ALT or AST rises above three times the upper limit, treatment is interrupted while the cause is investigated, and it is stopped for good if liver injury is confirmed with no other cause. Each fill comes with a Medication Guide. Febuxostat is not a controlled substance.

Taking Febuxostat

How to take it

Take one tablet by mouth once a day at about the same time each day, with or without food; antacids do not need to be avoided. Keep taking it during early gout flares, along with any flare prevention medicine prescribed, and do not stop without talking to the prescriber.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

At room temperature, 25 degrees C (77 degrees F), with brief excursions allowed from 15 to 30 degrees C (59 to 86 degrees F), protected from light, in the original container tightly closed and out of reach of children.

Interactions to know about

Febuxostat must not be used with azathioprine or mercaptopurine, and the label advises caution with theophylline.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Febuxostat differs from pharmacy to pharmacy

Febuxostat is a multisource generic, so most quotes are for a generic tablet and differ with the maker the pharmacy buys from and its own cash pricing. A prescription written for Uloric with substitution blocked is priced as a brand and costs far more.

Because the tablet is taken every day for the long term, small differences between pharmacies repeat with every refill. For a short fill of a low-cost generic, the dispensing fee can be a large share of the quote.

Ways to pay less for Febuxostat without insurance

• Ask the prescriber to write the generic name, febuxostat, and allow substitution, since AB-rated generics can be swapped for Uloric at the counter.
• Once the dose is settled after the first uric acid check, ask for a ninety-day supply.
• Compare more than one pharmacy and ask whether febuxostat is on a flat-price generic list.
• Ask the prescriber whether the flare prevention medicine (colchicine or an NSAID) can be filled at the same time, so both quotes can be compared together.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Febuxostat

1. 1.Do any of my other medicines, such as azathioprine, mercaptopurine or theophylline, interact with my febuxostat?
2. 2.What should I do if I have a gout flare in my first months on this tablet?
3. 3.Which heart or stroke symptoms mean I should get emergency care right away?
4. 4.Is the generic I am getting rated as equivalent to Uloric, and will the tablet look different between refills?

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