Febuxostat

INTRODUCTION

Indications

Chronic management of hyperuricemia in patients with a history of gout.

Action

Decreases production of uric acid by inhibiting xanthine oxidase. Therapeutic Effects: Lowering of serum uric acid levels with resultant decrease in gouty attacks.

Adverse Reactions/Side Effects

GI: liver function abnormalities, nausea. Derm: rash. MS: gout flare, arthralgia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of abnormal liver function, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician of these signs immediately.

• Assess joints affected by gout, and monitor pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's gout. Report any increased pain in joints (arthralgia) or gout flare-ups that might be related to drug treatment.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to decrease pain and help reduce the frequency and severity of gout attacks.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers about the signs of liver toxicity (see above in Examination and Evaluation). Encourage early recognition and notification of the physician or other health care professional about these signs.

• Instruct patient and family/caregivers to report severe or prolonged nausea or skin rash.

Pharmacokinetics

Absorption: Well absorbed (49%) following oral administration.

Distribution: Unknown.

Protein Binding: 99.2%.

Metabolism and Excretion: Extensively metabolized by the liver; minimal renal excretion of unchanged drug; 45% eliminated in feces as unchanged drug, remainder is eliminated in urine and feces as inactive metabolites.

Half-life: 5–8 hr.

Contraindications/Precautions

Contraindicated in: Concurrent azathioprine, mercaptopurine, or theophylline.

Use Cautiously in: Severe renal impairment (CCr <30 mL/min); Severe hepatic impairment; OB: Use in pregnancy only when potential maternal benefit outweighs potential fetal risk; Pedi: Safety in children <18 yr not established.

Interactions

Drug-Drug: Significantly ↑ blood levels of, and risk of serious toxicity from, azathioprine, mercaptopurine, and theophylline; concurrent use is contraindicated.

Route/Dosage

PO (Adults): 40 mg once daily initially; if serum uric acid does not drop to <6 mg/dL, dose ...