The Febuxostat Debate
I have recently extended the febuxostat information in the Gout Treatment section
This new uric acid lowering medication is now prescribed as Uloric in the USA, and adenuric elsewhere.
If you use it, or have questions that are not answered on the GoutPal.com site, please join this debate.
This gout treatment debate is a little less focused than other debates. Normally, I would limit it to side-effects, usability, or some other specific topic. In fact, as the debate here grows, I may well split the debate to smaller topics. For now, as this is a fairly new gout drug, I’m looking for any issues that are important to you.
So it’s over to you now. How are you affected by febuxostat?
Please read the gout debate guidelines before adding your comments.
The Febuxostat Debate: Related Topics
Please see these articles for explanations and more information:- Febuxostat Versus Allopurinol
- Author: Reinders MK, Jansen TL. Title: Management of hyperuricemia in gout: focus on febuxostat. Published: Feb 2010
- Febuxostat (Uloric & Adenuric) Fixes Gout
- Febuxostat is a recent addition to the uric acid lowering arsenal. Check if it is right for you, with this comprehensive guide.
- Uloric Prescribing Information
- Author: Takeda Pharmaceuticals America, Inc. Title: Uloric Prescribing Information. Published: Feb 2009.
- Uloric Adenuric Febuxostat Collection
- The Uloric Adenuric febuxostat collection is gout picture and gout PDF files about the new wonder-drug febuxostat.
- Uloric Gout Medicine: Best For Your Gout
- Uloric gout medicine is the best treatment for your gout, but does it's price put you off? Are you happy it's been tested enough
- Febuxostat FDA Approval Submission Briefing Document
- Febuxostat FDA approval document titled: Briefing Document for Febuxostat. Publication Date: Nov 2008. Author: Takeda Inc.
- Febuxostat: Be Euphoric About Uloric
- Febuxostat brings a new way to lower uric acid which is crucial to fixing your gout. Brand names include uloric and adenuric.
You can also search for related topics (febuxostat OR uloric OR adenuric):
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I have been on Uloric (20mg) for about 9 months. Seems I have all of the side effects. Am 66 years old, and have chronic gout since mid 30′s. Never had relief with Allopurinol and Uloric has reduced the incidents, but not without side effects. Weight gain, stiffness in muscles, restlessness, and anxiety. Dr. thought I should increase Uloric to 80mg and when I did that it resulted in a massive gout attack in my knees, ankles, both elbows, and swollen hands all at the same time. Took almost a month to get over it, with several injections of prednisone to help with the pain. I am now taking 1/2 (20mg) Uloric a day along with .6mg of cholchizine daily, and I am doing better.
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Thanks for sharing your experiences.
It’s an unfortunate side effect of ANY urate lowering therapy that the body can react to the drop in uric acid. When uric acid concentration in the blood falls, old crystals start to dissolve. As you have over 30 years of the crystals deposited all over your body, a reaction is almost to be expected.
That is the bad news, but the good news is that every day that more crystals dissolve, you reduce the risks of permanent tissue damage. Also. these attacks get less intense, and less frequent as you continue to rid your body of dangerous levels of urate.
I can understand that this painful side effect is a huge problem, but it has to be seen in context – if old urate deposits are dissolving, then temporary adverse effects should be seen as a positive indication of real progress. The key to this is not to manage the pain, but to manage your blood uric acid level. That is the only way to ensure that the dosage that you are getting is correct. The fact that gout pain lasted for almost a month, suggests to me that the dosage might not have been correct – but only frequent uric acid tests can determine this.
In that regard, Uloric is no different from allopurinol or any other urate lowering therapy. Management requires 3 phases:
1. Dose determination, where uric acid is measured, and dose adjusted every 2 to 4 weeks. This requires a target uric acid level for the second phase which must be below 6mg/dL. 5mg is good, but 3mg is better as it allows old urate deposits to dissolve quicker. This phase normally requires additional pain relief medicine (2 x .6mg colchicine daily is best).
2. Urate reduction, where uric acid is measured frequently to confirm that it is staying at the lowest target possible. Early in the phase, testing needs to be once a month, but as stability is proved, the frequency can be extended to 3 monthly intervals. Decreasing pain relief will also normally be required – prophylactic for a few months, then as required. This phase continues until there have been no gout flares for 6 months, whilst maintaining target uric acid level.
3. Maintenance phase, where uric acid is monitored approx. twice a year for ever. No pain relief is required, and normal life can continue. Uloric dosage can usually be relaxed slowly until stable readings no higher than 6mg/dL are reached. Whenever dosages are adjusted, test frequency should be every 2 to 4 weeks until stability is achieved.
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I have been using Uloric since Jan 2010. I had tried Allopurinol, but had a reaction to it and couldn’t take it. Uloric 40 mg lowered my UA from 9 to below 5 within 2 weeks and have remained there ever since. I have had no side effects to Uloric. I continued to have flare ups approximately 6 weeks for another 7 months, but have had no gout flare ups at all since August 2010. In addition to having had enough time to clear out old crystals, I also attribute the change to having started in August taking .3 mg colchicine phophalacticly. I continued that until a couple weeks ago and had one day of a little tingle; took .3 mg for 2 days and have had no other symptoms. Allopurinol is cheaper and has a long history of success (when take properly in high enough dose), but Uloric seems to be a great alternative for those that can’t take Allopurinol or find it not being effective.
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Oh davidk, I love it when a good plan comes to fruition.
This shows how now such a better time for gout sufferers who are allopurinol intolerant – they now have a choice.
I hope your success continues, and that you inspire other gout sufferers, who may have had problems with allopurinol, to try again, and get their uric acid under control.
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I have suffered from gout for 23 of my 48 years. The last 15 taking a daily combo of the usual three prescriptions. All that and still monthly flares getting as bed as weekly at the end of 2010 even when doubling up on the Allopurinol.
After drooping off a copy of the prescriber info I printed for him from the Uloric site and my Doctor’s sales man dropping off some samples of Uloric he agreed it was time to try something different. Until then my doctors position was allopurinal has worked for 100 years.
Finally, 2 weeks of 40mg and 2 weeks of 80mg samples.
First week on the 40mg and experienced some minor flaring, second week it got worse. after reading some articles I decided to stick it out. The next two weeks I used the 80mg Uloric……Hmm pain and swelling are going away…Could it be? Did someone finally get it right?
I am now on my third month of Uloric 80mg and have not had one major attack. Being the skeptic I am I have pushed all the wrong eating and drinking habits at times and this stuff seems to the real deal. I will sadly say the one thing that will start that dull twinge of pain before a full blown attack is beer. A couple of Indomethicin and it seems to stop it before it gets any worse. Oh well back to Vodka.
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23 years of gout, and not a single uric acid measurement!!??
If your doctor can’t regulate the dose of allopurinol to keep you gout free, what chance do you have with Uloric (febuxostat)?
This seems to highlight one of my major fears: a large proportion of allopurinol treatment failures are due to inadequate uric acid testing and associated lack of dose adjustment. How can this change with the same doctors prescribing a similar (yet much more expensive) gout medication?
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Having thought that I’d broken my toe playing rugby, I was eventually diagnosed with gout about 5 years ago to the utter delight of my friends who nicknamed me ‘Mr Bumble’ from Oliver Twist – one of these friends now has gout! Had 3 years on Allopurinol following high blood test readings and had no problems until I had a chest infection and the penicillin reacted with the Allopurinol resulting in three days in hospital on a steroid drip! Was banned from taking both of these resulting in me trying to control the uric acid naturally. Had 3 attacks in 6 month period and decided to make a real effort in changing my diet. Came on this and other sites daily and turned vegetarian. Cut out the beer and lost a stone gradually. Tried cherries, Honeygar and the blackbean soup with high intake of water to flush out the nasty bits!. Brought a Uric Acid Tester and kept detailed records for 3 months. Although I didn’t have any further attacks, only once did I manage to get my levels down below 6mmol (read on here the importance of getting it lower than this), and so I became a little depressed to say the least. I went to the doctors armed with references I had found on here and elsewhere relating to Febuxostat. The doctor hadn’t heard of it but looked it up and sent me to a specialist. Blood test readings were 489umol and 456 umol so well above the 350 µmol/L. Did other tests including urinating in a large bottle for 24 hours and liver function tests. Was put on Febuxostat (Adenuric 80mg) with cholchicine (for the first 3 months only) and I have just been back to the specialist 7 months after I started – my latest reading was 212 umol! – well below the 350 µmol/L. Since I have been on the Febuxostat, my dietry good intentions have slipped a little – I keep off red meat and the water intake is still high but I now have some chicken and fish – I can now enjoy a beer or three and my mental state has improved! So early signs on Febuxostat are promising and I’m glad I read this site back in those gloomy days of being willing to try anything to improve the situation
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Good News, Broken Toe! (good news about your progress – not a broken toe)
I would not worry about purine intake now – that’s what uric acid lowering meds are for. They deal with excess purines so you do not have to worry.
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Last year, July 2010, I woke up, and as usual got out of bed and could not stand on my feet. The pain was so intense that I had to be hospitalized (for 5 days) before I was diagnosed with GOUT. I was placed on 100mg Allopurinol (2xdaily) to ward of any further attacks, and Colchicine if the pain intensified. Later I was told not to take the two together. Then when Uloric appeared on the scene, I was told to stop taking those two medicines completely and only take the Uloric once a day.
I am baffled by all the talk of measures and levels. Neither my family physician, or the Gout physician, ever mentioned it and there is no monitoring involved.
I watch what I eat and drink, but I still have swelling of feet and hands (the two areas my Gout appeared initially) and tingling. Sometimes my feet and hands also itch and burn. I suppose I should be grateful that I have not had another attack, but I would be really grateful if all the symptoms would simply disappear. I take Uloric and 2 Advil each day and find that it helps me for exactly 24 hours. I am concerned with the intake of so much Advil.
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joanna38, you have been exceptionally badly advised. Both allopurinol and febuxostat (Uloric) serve the same purpose – to lower uric acid to safe levels. This is vital to stop uric acid crystals destroying your joints, but it can take several months, and only if the dose is sufficient to lower uric acid to 5mg/dL or below.
The numbers are a little confusing, because different scales are used in different countries. However, I have supplied a simple conversion calculator for uric acid, though really you should not need it much, because all you need to do is make sure your uric acid level is below 5mg/dL. You must take control of this. Your medical advisers have failed to do this properly, so if you do not take control, or at least change your doctor to someone who understands gout, then you will be condemned to unnecessary gout pain for years to come.
Colchicine is used for a completely different reason. Painful inflammation is possible until all old uric crystals are dissolved, and this will take several months. Colchicine will reduce this inflammation, though in my experience, you get better relief from a combination of colchicine and an anti-inflammatory such as ibuprofen or naproxen. Ask your pharmacist for pain relief advice to cover the months that the Uloric takes to get rid of all the old crystals. I should add that, as allopurinol is a much better and cheaper way to reduce uric acid, it is preferable to Uloric unless you are allergic to it (which you clearly are not).
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Hi GP
Thank u for the information and a great site!
I tried Allopurinol last year and I felt
Terrible !
I took 100 mg for 1 month and couldn’t stay awake!
My doc is suggesting Uloric
My UA level as of yesterday was 8.4
I know I need to do something
Are people experiencing drowsiness with
Uloric on your forums ?
I don’t see it anywhere
Thanx
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As reported in the main body, and confirmed by the Uloric prescribing information (http://www.goutpal.com/gout-treatment/avoid-gout/febuxostat-fixes-gout/uloric-prescribing-information/), drowsiness is reported as a side-effect in less than 1% of cases.
Personally, I feel this is probably a coincidence, where anxious patients are linking drowsiness with the specific drug. It is certainly not serious enough to warrant specific studies into a possible causal link.
In any event, one should never judge a medicine on how it works with other people. It is your reaction that is important, so try it if you must.
I am actually more concerned about your doctor’s advice re allopurinol.
Firstly, you should not be on 100mg for more than two weeks. Clearly, your dose is insufficient to get your uric acid to 5 or below. Maybe this is causing the drowsiness – your body telling you that you are not getting it right?
Secondly, allopurinol related drowsiness is reported as being a temporary reaction. Again, I can find no clear scientific study to support this view, but it is widely reported, and the survey at ehealthme.com has no reports of drowsiness after 6 months.
If you cannot get good advice on allopurinol which has safely controlled gout for over 40 years, what chance on febuxostat?
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Drowsiness is the same problem I had with Allopurinol. Or more accurately, I was in a fog and could not focus or concentrate on my work at all. I had to go off it after 2 weeks. I think that’s an extremely rare side effect and highly recommend people try allopurinol first because it’s been around so long with such a good track record. That said, for me, I then tried Uloric thanks to GoutPal’s recommendation and it dropped my UA from over 9 to 5 within 2 weeks. I had flare ups every 6 weeks for another 8 months, but ever since then, have not had a single flare up. I have been on Uloric 40 mg a little over 2 years now and my UA is consistently around 5.0. know your UA and get it down with Allopurinol if possible and if not, try Uloric.
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Dave, that is perfect. It is a great message to other gout sufferers – never give up the battle to get to 5! It makes perfect sense to try allopurinol first, as it is cheaper, and shown to be safely effective for many years. However, if you cannot tolerate it, many GoutPal members have achieved safe uric acid levels with febuxostat since it launched as Uloric in the States, and Adenuric elsewhere.
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Keith, let me add again another great message to other gout sufferers: I have been on Uloric 40 mg since July 2010 and Uloric 80 mg since December 2010. My present SUA is ~3 mg and I haven’t had an attack/flares/twinges for a whole year. I am brewing my own beer again (Hans in New Mexico Stout, 6-7% and making my own wines, 11-12%.) I am drinking 1 to 2 bottles of my home-brew every night and also have 6-12 oz of wine with my dinners. I interchange red meat, pork, chicken and fish and also eat mushrooms, asparagus, spinach (and other non-recommended vegetables) on a daily basis. While I still stay away from shellfish, liver and other high-purine foods, I have eaten once or twice shrimp, herring and tuna without ever having had an attack/flare-ups.
Please, gout sufferers, do NOT follow my example, unless YOU have your gout under control. I am only reporting this to show you that you can live a half-way normal life, provided you take control of your life/gout.
Keith has posted pictures of my right finger and right toe with tophi and open wounds at this time in April 2010. I shall supply new evidence what they look today, April 2012. Not only was I incapacitated for almost a year, today, at 81 1/2 I am proud to say that I sail and handle my 17 foot trimaran all by myself, sometimes going at 13-14 mph. Any mono or cat sailor will know that such speeds require a healthy body and mind.
Again:
Manage/control your gout!
Get a doctor, preferably a rheumatologist, who is knowledgeable about GOUT and will cooperate with you!
Know your SUA!
Bring it to/below 5 mg/dL = 0.3 mmol/L = 297 ?mol/L!
Stay tuned to GoutPal!
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When you refer to a swollen neck was it showing signs of fluid retention on both sides where it meets your shoulders?
Is it correct to say that the Allopurinol is not giving you any side effects whereas the Uloric was?
What doseage of Uloric weer you taking?
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My first Gout attack, 18 months ago, was so severe it landed me in hospital. Perhaps the severity was a result of not knowing what was happening to me.
I notice everyone mentioning measurements etc. With two doctors treating me neither one has ever mentioned measuring acidity and crystals etc.
I started out on Allopurinol and Colchicine and the relief was great! Then something happened and Colchicine was no longer available. I was switched to something else to replace the Colchicine, but that does not matter as I was taken off that when I was switched to Uloric. A couple of weeks ago I took myself off the Uloric and went back to Allopurinol. My moonface and swollen neck are back to normal although the swelling on ankles and feet have not completely disappeared, but not bad at all. I also find that I have a lot more fluid release from Allopurinol than I did with Uloric…and that is a good thing.
All in all I have accepted that I have to live with this until something comes along that will clear this out of our systems forever.
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Forgot to mention…the drowziness! Oh for sure I have becme a NODDER now that I am back on Allopurinol.
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Joanna, you still haven’t told us what your SUA level is. Unless/until you, your doctors and we know that, all you do is whistling Dixie.
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Taking 80 mg Febuxostat since 17Feb 2012 and it has been most successful but recently I have been experiencing “ringing in my ears”. I’m not certain if this is due to the medication or not but I would be keen to know if anybody else has had a similar experience?
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My first gout attack was in 2004. The most recent episodes started around june 2011 in my wrist. Then in november 2011 my big toe on my right foot flared up. After that my left ankle had a gout attack and that lasted until march 2012 on and off.
I finally gave in and took allopurinol 100mg for a week, but i was having itchy skin and rashes. then the doctor put me on uloric 40mg and its been working great. My ua level was never really high about 6.3mg/dl after taking uloric for 2 weeks the results came back at 3mg/dl.
All the flareups have stopped and my ankle is back to normal. I stopped avoided food that usually gives me flareups like seafood and beans.
My first prescription of 30 tablets 40mg uloric was covered by my insurance and was $45 dollars out of my own pocket, but i went to http://www.uloric.com/savings/ and signed up for their coupon. After I gave that to my pharmacy I only had to pay $20 dollars for it.
When it was time to get a refill I asked my doctor if he could give me the 80mg of uloric and then I use a pill splitter. He said yes and he went ahead and prescribed me 45 pills of 80mg uloric. The pharmacy filled it and it was still the same price for me $20 dollars. This is something you guys might want to explore to save some money if you only need 40mg to lower your ua level
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That is great that you have the gout under control with Uloric. Thanks for the money-saving tip about splitting 80mg pills – febuxostat seems a great alternative for gout patients who cannot tolerate allopurinol. Now, cost is less of an issue – $20 for 45 days gout treatment sounds good.
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Did you have any issues with side effects with the Uloric or are you aware of any ?
It is of interest that you have been taking 40mg whereas I have been taking 80 mg since 17.2.’12 and my initial levels were similar to yours. I realise it’s a question for a rheumatologist but I wonder if there is any merit in considering reducing the 80 mg dose?
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Frank, ask your doctor to give you a ua test and see what your ua level is on 80mg uloric. If its healthy, I would ask the doctor if you could reduce it to 40mg and test it again to see if it stays similiar at a similiar level. If it does I would say your safe to take 40mg of uloric, but im not a doctor lols.
as for the ringing of the ears, I am not experiencing any signs of that with uloric but when i was taking indomethican for gout I was having that problem and I found out that its called “tinnitus”. Uloric has that listed as a side effect also. I would be listening to a conversation and suddenly my ears would “pop” and everything would sound louder and i hear a whoozing sound. But after a little while it would go away
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