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For the clinical use of febuxostat, these 5 points are enough!

 Last Update: 2021-10-10
 Source: Internet
 Author: User

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Febuxostat by inhibiting xanthine oxidase (XO), and inhibit the formation of uric acid
.

Allopurinol can inhibit reduced XO, while nonbuxostat has a good inhibitory effect on reduced and oxidized forms, so the effect of lowering uric acid is stronger and faster

Febuxostat febuxostat by inhibiting xanthine oxidase (XO), uric acid generation is suppressed

Febuxostat is suitable for long-term use in patients who have a history of gout or have gout in persistent hyperuricemia
.

It is also recommended to use anti-inflammatory drugs in combination with uric acid lowering in the acute stage of gout attacks

Febuxostat is suitable for long-term use in patients who have a history of gout or have gout in persistent hyperuricemia

The FDA only recommends it for patients whose treatment with allopurinol is ineffective, or who have had serious adverse reactions with allopurinol

Febuxostat is available in 10 mg, 20 mg, 40 mg, and 80 mg specifications.

There are 10 mg, 20 mg, 40 mg, and 80 mg specifications .
Before taking the medicine, you should check which specifications you are taking

* Recommended initial dose of 20mg once daily , , review of blood uric acid, uric acid increases gradually in accordance with the amount of medication after 2 to 5 weeks, each incremental 20mg, maximum daily dose of 80 mg of

*In the early stage of treatment, the rapid decrease in blood uric acid level may cause more urate deposited in the tissues to be mobilized, leading to an increase in the frequency of gout attacks

* For the prevention of gout treatment of early onset of prevention , recommends that small dose and gradually increase the amount , , and the use of colchicine and nonsteroidal anti-inflammatory drugs (such as ibuprofen, etc.

* Patients with acute attacks of gout should control their gout symptoms before using febuxostat

Notes Notes

*Febuxostat's inhibitory effect on XO may increase the plasma concentration of drugs metabolized by this enzyme, such as azathioprine, mercaptopurine, and theophylline, resulting in toxicity, so it is prohibited for patients who are using these three drugs
.

*I need to remind everyone that febuxostat can control gout but not cure gout
.

Uric acid-lowering treatment for gout patients is a long-term process.
After the blood uric acid drops to the standard, the drug cannot be stopped at will.
It is necessary to reduce or stop the drug according to the doctor's advice according to the uric acid level
.

*I need to remind everyone that febuxostat can control gout but not cure gout
.
Uric acid-lowering treatment for gout patients is a long-term process.
After the blood uric acid drops to the standard, the drug cannot be stopped at will.
It is necessary to reduce or stop the drug according to the doctor's advice according to the uric acid level
.

Without disabling uric acid lowering drugs easily lead to blood uric acid levels returned to pre-treatment, not only can cause gout attacks again, and uric acid non-compliance will bring long-term kidney and cardio-cerebral vascular risk of damage
.

Drug therapy is an important measure to treat gout, but life>
.

* Life>
.
If you have to drink, red wine can be used in moderation
.
Also control weight
.

People who are not suitable for febuxostat

►Patients with a history of allergies to the ingredients of Febuxostat tablets
.

►Patients who are taking mercaptopurine or azathioprine, because febuxostat may increase the blood concentration of azathioprine, mercaptopurine and theophylline and increase toxicity
.

►There is currently no study on the use of febuxostat in patients with secondary hyperuricemia.
Therefore, it is not recommended for patients with secondary hyperuricemia
.

►It is not recommended for patients with asymptomatic hyperuricemia
.

Febuxostat does not have an inhibitory effect on enzymes other than xanthine oxidase.
Therefore, its safety is relatively high, but it is necessary to pay attention to its adverse reactions
.
*Febuxostat is mainly metabolized in the liver, and the metabolized inactive substances are excreted through the kidneys, feces and bile in multiple ways.
Febuxostat reduces the formation of renal interstitial fibrosis and exerts renal protection
.
Febuxostat may have the effect of delaying or preventing renal interstitial fibrosis in patients with CKD
.

* Liver damage : the incidence of 2% to 3%, expressed as fatigue, loss of appetite, right upper abdominal discomfort, soy sauce colored urine, jaundice, diarrhea and so on
.

Treatment measures : Before using febuxostat for the first time, the patient should check liver function as a baseline level
.
When taking medicine

* Liver damage : the incidence of 2% to 3%, expressed as fatigue, loss of appetite, right upper abdominal discomfort, soy sauce colored urine, jaundice, diarrhea and so on
.
Measures : : the first use of febuxostat before him, the patient should check liver function as a baseline
.
When taking medicine

When the above symptoms of liver damage appear, liver function should be checked
.

Slightly elevated liver enzymes (2 times lower than the upper limit of the normal reference value) can be followed up for observation, and most of them can gradually return to normal
.
When the increase in liver enzymes exceeds the upper limit of the normal reference value by 2 times, hepatoprotective treatment is recommended.
When the upper limit of the normal reference value is exceeded 3 times, the dose should be reduced or the drug should be discontinued as appropriate.
Generally, after drug withdrawal or liver protection treatment, liver function is impaired Symptoms can be relieved
.

*It has high safety in patients with renal insufficiency and renal transplantation.
Patients with mild to moderate renal insufficiency (eGFR≥30ml/min) do not need to adjust the dose
.
For the treatment of hyperuricemia in patients with chronic kidney disease, Chinese and foreign guidelines for the diagnosis and treatment of hyperuricemia recommend the use of febuxostat to a certain extent
.
For patients with severe renal insufficiency (eGFR<30 ml/min), many studies have shown the effectiveness and safety of febuxostat.
The recommended starting dose is 20 mg once a day
.

Treatment measures: Patients with mild or moderate liver insufficiency (Child-Pugh A and B) do not need to adjust the dose.
There is no sufficient research data for severe liver insufficiency (Child-Pugh C).
Such patients should be used with caution
.

* Skin reactions: manifested as skin allergies, rashes, itching, blisters, peeling and so on
.

Treatment measures: If a serious skin reaction is suspected, febuxostat should be discontinued and seek medical attention promptly
.
If the patient has reported similar skin reactions when using allopurinol, febuxostat should be used with caution
.
* Cardiovascular disease-related deaths : Studies have shown that compared with allopurinol, febuxostat causes an increase in cardiovascular-related deaths
.

* Skin reactions: manifested as skin allergies, rashes, itching, blisters, peeling and so on
.
Treatment measures: If a serious skin reaction is suspected, febuxostat should be discontinued and seek medical attention promptly
.
If the patient has reported similar skin reactions when using allopurinol, febuxostat should be used with caution
.
* Cardiovascular disease-related deaths Cardiovascular : Studies have shown that compared with allopurinol, febuxostat causes an increase in cardiovascular-related deaths
.

The purpose of this study is to remind doctors and patients to use the drug more rationally, rather than denying its efficacy.
This is why the FDA restricts it to only use allopurinol to treat patients who are ineffective or who have serious adverse reactions when using allopurinol.
Reason
.

Treatment measures: When deciding to use febuxostat, it should be fully evaluated.
Patients with a history of cardiovascular disease or risk factors should be used with caution, and patients should be followed up to monitor the occurrence of cardiovascular thrombotic events
.

For patients with a history of heart disease or stroke, the risks and benefits need to be carefully weighed
.

If you experience chest pain, shortness of breath, rapid or irregular heartbeat, numbness or weakness on one side of your body, dizziness, difficulty speaking, and sudden severe headache while taking febuxostat, you should seek medical attention immediately
.

Special group use matters

The FDA's pregnancy safety classification is C: There are no adequate controlled studies in pregnant women
.
Febuxostat should be used during pregnancy only if it is confirmed that the potential benefits outweigh the risks to the fetus
.

The safety classification of febuxostat during lactation is L3
.
Studies on rats have found that febuxostat can be excreted in milk
.
However, it is not known whether febuxostat is excreted in human milk
.

Since many drugs can be secreted into breast milk, women who are breastfeeding should use this product with caution
.
Breastfeeding women should stop breastfeeding during the administration of this product
.

The safety and effectiveness of febuxostat in the treatment of patients under 18 years of age have not been established, and it is not recommended for children under 18 years of age
.

The safety and effectiveness of febuxostat in the treatment of patients under 18 years of age have not been established, and it is not recommended for children under 18 years of age
.
child

Elderly patients do not need to adjust the dose
.

Summarize

Summary Febuxostat, as a new xanthine oxidase inhibitor, has a clear uric acid-lowering effect, and provides a medication option for the treatment of patients with gout and hyperuricemia
.
In the process of clinical application of febuxostat, one should be alert to the adverse reactions and risks of the drug, and attention should be paid to prevent xanthine oxidase inhibitor withdrawal syndrome
.
At present, rheumatoid immune physician for gout, hyperuricemia in patients considered for febuxostat when uric acid lowering therapy, should weigh the risks and benefits, judged according to the patient's specific situation, objectively evaluate the clinical significance of drug use
.
Immunological references: 1.
Valerie Gerriets;IshwarlalJialal.
Febuxostat.
StatPearls[Internet].
May 17,2020.
2.
Richette P,Doherty M,et al.
2016updated EULAR evidence-based recommendations for the management of gout.
AnnRheum Dis.
2017 Jan;76(1):29-42.
3.
FitzGerald JD, Dalbeth N, MikulsT, et al.
2020 American College of Rheumatology Guideline for the Management ofGout.
Arthritis Rheumatol.
2020 Jun;72(6):879-895.
doi:10.
1002/art.
41247.
3.
Endocrinology Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019)[J],Chinese Journal of Endocrinology and Metabolism.
2020,36(1).
1-12.
Diagnosis and treatment 4.
Wang Yu, Xie Yifan, Zhang Zhuoli.
Also talk about the cardiovascular safety of febuxostat.
Journal of Adverse Drug Reactions.
2020.
22(8):445-449.
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