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Brand names: Uloric • Drug class: Xanthine oxidase inhibitor
Febuxostat is the main alternative to allopurinol for lowering uric acid in gout — and it does not require the same slow renal titration, since it's mostly metabolized by the liver. Its role in CKD is significant: gout is common and NSAIDs are often off-limits.
Febuxostat is metabolized hepatically, so renal dose adjustment is not required like allopurinol's oxypurinol accumulation. It's effective in advanced CKD where allopurinol dosing gets restrictive. The CARES trial compared cardiovascular outcomes vs allopurinol; the FDA retains a warning about cardiovascular mortality in that trial — discussion with a prescriber matters in patients with heart disease.
Non-inferior urate lowering vs allopurinol in gout trials
FACT study, NDT 2008, 2008
CARES trial: numerically higher cardiovascular deaths vs allopurinol — FDA warning retained
White WB et al., NEJM 2018, 2018
No dose adjustment for renal function; 40 mg once daily, up to 80 mg if urate target not met. Contraindicated with azathioprine/6-mercaptopurine (increases their levels dangerously).
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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