Uloric (Febuxostat)

Uloric Information:

Uloric (generic name febuxostat) is a uric acid lowering agent that is used to minimize the occurrence of gout attacks in patients predisposed to gout attacks. Uric acid which causes gout is caused by the breakdown of purines in the body, Uloric works by inhibiting this breakdown and results in a decreased level of Uric acid being produced from purines.

How does Uloric compare to other gout medications (colchicine, allopurinol)?
Uloric is a different medication than colchicine. Colchine is used to treat a gout attack when a patient is experiencing the pain of gout. Uloric will NOT treat an acute gout attack and will many times worsen the gout pain if used in the acute treatment of gout. Allopurinol is a very similar medication to Uloric and belongs to the same drug class. Uloric also has a similar side effect profile to Allopurinol. There exists a certain amount of debate as to which medication is better or more efficient in preventing gout. However in 3 head to head studies, it was discovered that patients achieved a much lower target uric acid level with Uloric 80mg after 6months. Uloric also differs from Allopurinol in that it requires no dose adjustment in liver or kidney failure.

Uloric Side Effects:

The most common side effects and their percentage occurrence are listed below.
-liver function abrormalities (4.6%)
-diarrhea (3%)
-rash (1.3%)
-nausea (1.3%)
-dizziness (1.1%)

Are there any food or drug interactions with Uloric?
There exist no food interactions with Uloric, however, it is advised that the patient avoid foods that may contribute to increased uric acid levels which may lead to a gout attack. Such foods include high protein white meat, red meat, fish, and even alcohol. Uloric is generally free of drug interactions, HOWEVER, the following 3 drugs will interact with Uloric and can cause a dangerous increase in the levels of the following.
1. Azathioprine.
2. Mercaptopurine.
3. Theophylline.

Uloric Directions:

How do I take Uloric?
Uloric is supplied as a 40mg and 80mg tablet and is taken once daily with or without food. A patient will usually be started at a 40mg dose and if he does not achieve target uric acid levels with this dose, the dose will be increased to 80mg. There is a chance that a patient may experience an event caused a gout flare when initiating treatment with Uloric. Such an event is similar to an acute gout attack. Usually this is managed by concurrently taking an NSAID (anti-inflammatory) medication with Uloric when initiating treatment. The physician will discuss how long to continue an NSAID when initiating Uloric.

Uloric Precautions:

Uloric and the chances of MI (heart attack) and stroke
In randomized trials it has been discovered that a higher percentage of patients experienced cardiovascular events when treated with Uloric. These events include such things as strokes, heart attacks, and clots. The cause of this has not been discovered, and it is important to note that this has not occurred with Allopurinol. It is advised that the patient monitor for any signs and symptoms of any cardiovascular events (ex. Chest pain). Also, if a patient is predisposed to cardiovascular events or if he has had a previous cardiovascular event, it is suggested that the patient look for alternate therapies in managing gout (ex. Allopurinol).

IMPORTANT COUNSELLING POINTS
1. Uloric DOES NOT treat a gout attack and should not be started when a patient is experiencing an acute attack of gout.
2. Patients should be advised to obtain liver function tests before starting Uloric treatment and periodically every 3-6 months during treatment.
3. Patients should be counselled that an acute gout flare may occur and that initiating therapy with an NSAID (anti-inflammatory) will reduce this occurrence.
4. Patients with previous cardiovascular events (ex. Heart attack or strokes) or at risk of cardiovascular events should not use Uloric.