If you suffer from gout, what should you pay attention to when using Febuxostat?

I saw a message from a friend. He had a gout attack some time ago. Now that he is stable, he wants to use medicine to control uric acid and prevent gout recurrence. He saw that there are three commonly used drugs for controlling uric acid, namely allopurinol, febuxostat, and benzbromarone. Which one is more suitable?

Huazi said that judging from the drug's mechanism of action and metabolic pathway, Febuxostat has lower adverse reactions, fewer restrictions, and is suitable for more people.

1. Febuxostat, which inhibits uric acid synthesis

The source of uric acid in the human body is 20% from the diet, and 80% is synthesized by the body. Therefore, simply controlling diet is not effective in reducing uric acid. Most people with hyperuricemia need to use medication.

Among the uric acid-lowering drugs, allopurinol and febuxostat are both drugs that inhibit uric acid synthesis .

Allopurinol may cause life-threatening hypersensitivity reactions, which are associated with the HLA-B5801 gene. The positive rate of this gene in the Chinese population is 10% to 20%. Genetic testing is required before using allopurinol, which is relatively cumbersome. Allopurinol may cause kidney damage, and the dosage needs to be adjusted according to kidney function during medication.

Compared with allopurinol, febuxostat has a stronger inhibitory effect on xanthine oxidase and a better effect on lowering blood uric acid . Febuxostat is mainly metabolized by the liver and has no effect on renal function.

Benzbromarone is a drug that promotes uric acid excretion. A large amount of uric acid is excreted in the urine. If you do not drink enough water or urinate too little, uric acid stones are likely to form. People who already have kidney stones or severe renal insufficiency should not use benzbromarone.

Therefore, compared with the three, Febuxostat is safer and has a wider range of applicability .

2. What should I pay attention to when using Febuxostat?

1. Can it be used by people without gout symptoms?

When blood uric acid levels rise, it can cause joint pain (gouty arthritis), uric acid nephropathy, and kidney stones, all of which are called gout. If gout symptoms occur, active uric acid-lowering treatment is necessary.

The instructions for use of Febuxostat state that it is "not recommended for asymptomatic hyperuricemia", but this does not mean that it cannot be used without symptoms. For patients without gout symptoms but with blood uric acid levels exceeding 540, combined with stones or renal insufficiency, Febuxostat is still a good choice and can be used under the guidance of a doctor.

2. Know when to take medication

Uric acid-lowering treatment cannot be started at will, but the timing of medication needs to be mastered. It is recommended to start taking uric acid-lowering drugs 2 to 4 weeks after the acute attack of gout is completely relieved .

This is because after taking uric acid-lowering drugs, the uric acid level in the blood is significantly reduced, which will stimulate the surface of tophi to dissolve and release uric acid, aggravating local inflammatory irritation, which may aggravate gout symptoms or induce gout.

Therefore, in the first 2 weeks of taking Febuxostat, you can use it in combination with a small dose of colchicine or nonsteroidal anti-inflammatory drugs to prevent acute gout attacks. If gout occurs during medication, you do not need to stop the medication and can continue treatment .

3. Pay attention to the adverse reactions of Febuxostat

In clinical trials abroad, Febuxostat increased the risk of cardiovascular events in gout patients. Therefore , the elderly with cardiovascular and cerebrovascular diseases should use Febuxostat with caution . During medication, it is necessary to pay close attention to chest pain, limb numbness and other signs of myocardial infarction and stroke. If there are any abnormalities, seek medical attention in time.

Febuxostat is metabolized by the liver and may cause abnormal liver function. If you experience fatigue, loss of appetite, darker urine color, etc. during medication, you should seek medical attention and check your liver function. If the transaminase exceeds 3 times the normal upper limit, you should stop taking the medication .

In summary, Febuxostat is a commonly used uric acid-lowering drug. Compared with other uric acid-lowering drugs, it has no effect on kidney function and is suitable for patients with hyperuricemia who have gout symptoms. When taking the drug, you must master the timing of medication and adverse reactions. The drug needs to be used under the guidance of a doctor. If you have any questions about the medication, you should consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.