febuxostat
febuxostat
Pharmacologic class: Xanthine oxidase inhibitor
Therapeutic class: Antigout agent
Pregnancy risk category C
Action
Decreases serum uric acid level
Availability
Tablets: 40 mg, 80 mg
Indications and dosages
➣ Long-term management of hyperuricemia in patients with gout
Adults: Initially, 40 mg P.O. daily; for patients who don't achieve serum uric acid level of less than 6 mg/dl after 2 weeks with 40 mg, give 80 mg P.O. daily
Contraindications
• Concomitant use of azathioprine, mercaptopurine
Precautions
Use cautiously in:
• severe hepatic or renal impairment
• patients with greatly increased rate of urate formation, such as in malignant disease and its treatment and Lesch-Nyhan syndrome (use not recommended)
• concurrent use of theophylline
• pregnant or breastfeeding patients
• children younger than age 18 (safety and efficacy not established).
Administration
• Administer with or without food.
Adverse reactions
CNS: dizziness, nonfatal cerebrovascular accident (CVA)
CV: cardiovascular thromboembolic events (nonfatal myocardial infarction [MI], deaths)
GI: nausea
Hepatic: liver function abnormalities
Musculoskeletal: arthralgia
Skin: rash
Interactions
Drug-drug. Drugs metabolized by xanthine oxidase (such as azathioprine, mercaptopurine): may increase plasma concentrations of these drugs, leading to severe toxicity
Theophylline: altered theophylline metabolism
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase: increased levels
Patient monitoring
See Monitor patient for signs and symptoms of MI or CVA.
• Be aware that gout flares (caused by reduction in serum uric acid levels resulting in mobilization of urate from tissue deposits) may occur. To prevent such flares, provide concurrent prophylactic treatment with a non-steroidal anti-inflammatory drug or colchicine, as prescribed.
• Monitor liver function tests 2 months and 4 months after starting therapy and periodically thereafter.
Patient teaching
• Instruct patient to take drug with or without food.
See Instruct patient to immediately report cardiovascular symptoms (such as shortness of breath or chest pain) or strokelike symptoms (such as headache or dizziness) to prescriber.
• Tell patient to inform prescriber of increased gout symptoms or rash.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
febuxostat
(fe-bux-o-stat) febuxostat,Uloric
(trade name)Classification
Therapeutic: antigout agentsPharmacologic: xanthine oxidase inhibitors
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | rapid | 1–1.5 hr* | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Gastrointestinal
- ↑ liver function tests
- nausea
Dermatologic
- rash
Musculoskeletal
- gout flare
- arthralgia
Interactions
Drug-Drug interaction
Significantly ↑ levels of and risk of serious toxicity from azathioprine and mercaptopurine ; concurrent use is contraindicated.May ↑ levels of theophylline ; use cautiously together.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Assess for joint pain and swelling, especially during early therapy. Changing serum uric acid levels from mobilization of urate from tissue deposits may cause gout flares. Use prophylactic NSAID or colchicine therapy for up to 6 mo. If a gout flare occurs, continue febuxostat therapy and treat flare concurrently.
- Monitor for signs and symptoms of MI and stroke.
- Lab Test Considerations: Monitor serum uric acid levels prior to, 2 wk after intitiating, and periodically thereafter. If serum uric acid levels are ≥6 mg/dL after 2 wk of daily 40 mg therapy, increase dose to 80 mg daily.
- Monitor liver function at 2 and 4 mo of therapy and periodically thereafter. May cause ↑ AST, ALT, CPK, LDH, alkaline phosphatase, and creatine.
- May cause prolonged aPTT and PT, and ↓ hematocrit, hemoglobin, RBC, platelet count, and lymphocyte, neutrohpil counts. May cause ↑ or ↓ WBC.
- May cause ↓ serum bicarbonate and ↑ serum sodium, glucose, potassium, and TSH levels.
- May cause ↑ serum cholesterol, triglycerides, amylase, and LDL levels.
- May cause ↑ BUN and serum creatinine and proteinuria.
Potential Nursing Diagnoses
Chronic pain (Indications)Implementation
- Oral: May be taken with or without food and with antacids.
Patient/Family Teaching
- Instruct patient to take febuxostat as directed. If a gout flare occurs, continue febuxostat and consult health care professional; medications to manage gout flare may be added.
- Advise patient to notify health care professional if rash, chest pain, shortness of breath, or stroke symptoms (weakness, headache, confusion, slurred speech) occur or if side effects are persistent or bothersome.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products.
- Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.
- Emphasize the importance of follow-up lab tests to monitor therapy.
Evaluation/Desired Outcomes
- Reduction in serum uric acid levels and resultant gout attacks.