Febuxostat is preferred over allopurinol in patients with renal impairment for gout management. The primary pharmacological difference explaining this preference is:
- A Febuxostat is a non-purine selective xanthine oxidase inhibitor cleared primarily hepatically, not requiring dose adjustment in mild-to-moderate CKD ✓
- B Febuxostat inhibits both xanthine oxidase and URAT1 providing dual urate lowering in renal disease
- C Febuxostat's active metabolite oxypurinol is non-toxic to renal tubules unlike allopurinol
- D Febuxostat directly increases renal uric acid excretion independently of xanthine oxidase inhibition
Correct answer: A. Febuxostat is a non-purine selective xanthine oxidase inhibitor cleared primarily hepatically, not requiring dose adjustment in mild-to-moderate CKD
Explanation
Allopurinol and its active metabolite oxypurinol are primarily renally excreted; dose reduction is required in CKD to avoid oxypurinol accumulation and serious adverse effects including allopurinol hypersensitivity syndrome. Febuxostat is a non-purine selective xanthine oxidase inhibitor metabolized predominantly by the liver (UGT and CYP pathways), with dual renal and hepatic excretion, allowing use without dose adjustment in eGFR 15-89 mL/min. This pharmacokinetic difference makes it safer in CKD.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.