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Febuxostat vs. Allopurinol

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson goes over a couple of similar medications called febuxostat and allopurinol. You'll learn what they're used for and some of the similarities and differences they have.

Uric Acid

Too much uric acid in the blood, something called hyperuricemia, can lead to the formation of uric acid crystals, which can then lodge themselves into a person's joints and lead to a condition known as gout, a kind of very painful arthritis. Keep this in mind as we compare and contrast two medications known as febuxostat and allopurinol.

Brand Names & Indications

Febuxostat is the generic name for a medication known as Uloric and allopurinol is a generic compound that goes by brand names such as Aloprim and Zyloprim

Febuxostat is indicated for the chronic (long-term) management of hyperuricemia in people with gout. This means it's not recommended to be used to manage asymptomatic hyperuricemia.

Allopurinol is indicated to treat gout and hyperuricemia caused by cancer therapy for cancers like leukemia and lymphoma. Allopurinol has also been shown to be effective in treating recurrent calcium oxalate calculi in patients with excessive uric acid excretion in the urine.

Pharmacology & Administration

Both febuxostat and allopurinol can be classified as xanthine oxidase inhibitors. In other words, they work by inhibiting an enzyme called xanthine oxidase. In the end, this means the body makes less uric acid.

Febuxostat comes in oral tablets while allopurinol comes in oral tablets as well as an intravenous solution. Febuxostat can be given with or without meals or antacids. Allopurinol should be given after meals when given orally and with sufficient fluids. This means the patient should have a daily urinary output of no less than 2 liters and a neutral or slightly alkaline urine.

Both medications peak in plasma around 1-1.5 hours after oral administration.

Warnings & Adverse Reactions

Neither medication should be given to anyone with a known hypersensitivity (allergy) to the medication or any other ingredient in the formulation they are being given. Febuxostat shouldn't be given to people taking medications called azathioprine, theophylline, or mercaptopurine. While not a contraindication to its use in the U.S., allopurinol should be given carefully, or not at all, in the following situations:

  • To breast-feeding mothers and children. The one exception is those that have Lesch-Nyhan syndrome or those with hyperuricemia due to cancer therapy.
  • Individuals with the HLA-B*5801 genotype.

Some of the more commonly reported side effects associated with febuxostat include rash, nausea, liver dysfunction, and joint pain. In comparison, some of the more commonly reported adverse reactions of allopurinol include rash, nausea, diarrhea, and liver dysfunction.

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