Febuxostat (Uloric)

Febuxostat (Uloric) is a medication used to treat gout by lowering uric acid levels. When uric acid levels are too high in the body, it can build up in joints and form sharp needle shaped crystals that cause sudden and severe joint pain and swelling known as gout attacks or flares. Febuxostat works by blocking an enzyme called xanthine oxidase that normally break down certain proteins (purines) into uric acid.

This medicine is recommended only for people who can’t take allopurinol or didn’t improve after trying adequate doses of allopurinol. This is because in one clinical trial, more deaths from heart related causes, including heart attacks and strokes, were seen in people with gout and heart disease who took febuxostat compared to a similar group who took allopurinol. Additional clinical trials designed to look for cardiovascular (heart disease) complications and deaths from heart disease have not shown similar findings.

How to Take It

Febuxostat is taken as a pill once every day. The recommended starting dose for most people is 40 mg daily. The dose may be increased after at least two weeks if your blood uric acid level is higher than 6 mg/dL. People who are starting gout treatment with febuxostat should also be prescribed a second medication, like colchicine or ibuprofen, to prevent gout attacks. Febuxostat should be taken every day or as prescribed, skipping doses or stopping this medication increases the risk of having more gout attacks.

Side Effects

This medication should not be used if you are taking azathioprine or mercaptopurine as febuxostat can increase the blood levels of these medicines which may lead to toxic side effects.

Side effects are possible with any medication. People who take febuxostat may experience diarrhea or nausea, rashes, allergic reactions, and abnormal liver tests. Febuxostat contains lactose and gastrointestinal side effects may be more common in people who are lactose intolerant.

More frequent gout attacks have also been noted in patients when starting febuxostat and can be prevented by taking a second medication as prescribed by your rheumatology provider. If gout attacks occur while on febuxostat, these symptoms can be treated with NSAIDs or glucocorticoids (also known as steroids) but febuxostat should not be stopped. Blood tests are recommended during treatment with febuxostat.

Tell Your Rheumatology Provider

Before starting this medication: If you have any history of heart disease or strokes, if you are pregnant, considering pregnancy, or breastfeeding. You should also make sure to review all your medications and any supplements with your rheumatology provider.

If you are taking febuxostat and develop chest pain, chest pressure, shortness of breath, weakness or numbness in an arm, leg, or one side of your face, or symptoms of an allergic reaction, tell your rheumatology provider immediately or seek emergency medical care.

Febuxostat has not been studied in people who are pregnant or breastfeeding and it is not recommended for use in these groups.

Updated March 2024 by Elizabeth Graef, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.