A 55-year-old man with gout has a serum urate of 9.8 mg/dL and has had three attacks in the past year. He has a history of allopurinol hypersensitivity syndrome. Which urate-lowering therapy is most appropriate?
- A Probenecid
- B Rasburicase
- C Febuxostat ✓
- D Lesinurad monotherapy
Correct answer: C. Febuxostat
Explanation
Febuxostat is a non-purine selective xanthine oxidase inhibitor and is the preferred alternative for patients with allopurinol hypersensitivity or intolerance. It does not cross-react with allopurinol. Probenecid (a uricosuric agent) requires adequate renal function (eGFR >45–50) and is less effective as monotherapy. Rasburicase is used only for tumor lysis syndrome. Lesinurad is a uricosuric agent approved only in combination with a xanthine oxidase inhibitor, not as monotherapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.