Febuxostat for Treatment of Chronic Gout

Charnelda L. Gray, Pharm.D., BCPS; Nafesa E. Walters-Smith, Pharm.D., BCPS


Am J Health Syst Pharm. 2011;68(5):389-398. 

In This Article

Dosage and Administration

Febuxostat was approved for the chronic management of hyperuricemia in patients with gout, with recommended dosages of 40 and 80 mg once daily.[30] The recommended initial dosage of febuxostat is 40 mg orally once daily with or without food. The target serum uric acid concentration is <6 mg/dL. Prophylaxis is recommended due to the risk of an acute gouty flare. Prophylaxis may by warranted for an extended period of time as patients receiving febuxostat monotherapy developed flares frequently.[26] The manufacturer recommends flare prophylaxis with NSAIDs or colchicine.[30] If the target serum uric acid concentration is not reached after two weeks, the dosage of febuxostat may be increased to 80 mg orally once daily. Patients with mild-to-moderate hepatic or renal impairment do not require additional dosage adjustments. However, caution should be encouraged in patients with severe renal insufficiency (CLcr of <30 mL/min) or severe hepatic impairment (Child-Pugh class C). Although the 120-mg dose was evaluated in clinical trials, that dosage is not in the approved labeling. Dosages of febuxostat should be adjusted to achieve serum uric acid concentrations of <6 mg/dL.[27]


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