Febuxostat, unlike allopurinol, is a non-purine selective xanthine oxidase inhibitor. Its main advantage over allopurinol in certain patients is:
- A It can be used at full dose without dose adjustment in mild-to-moderate chronic kidney disease ✓
- B It has no risk of precipitating acute gouty flares during initiation
- C It also inhibits uric acid reabsorption (URAT1) providing dual urate-lowering action
- D It is safe in patients with allopurinol hypersensitivity syndrome and requires no HLA-B*5801 screening
Correct answer: A. It can be used at full dose without dose adjustment in mild-to-moderate chronic kidney disease
Explanation
Febuxostat is predominantly hepatically metabolised and excreted via bile, making dose adjustment unnecessary in mild-to-moderate CKD (eGFR > 15–30 mL/min), unlike allopurinol which requires renal dose adjustment. Both agents can trigger flares during initiation (requiring prophylactic colchicine). Febuxostat does not inhibit URAT1. Patients with allopurinol hypersensitivity can use febuxostat, though HLA-B*5801 is relevant to allopurinol, not febuxostat.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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