FEBO-G 40mg Tablets 20s

Febo-G contains Febuxostat, a non-purine selective inhibitor of xanthine oxidase (XO), the enzyme responsible for converting hypoxanthine to xanthine and xanthine to uric acid.

By blocking XO, Febuxostat reduces uric acid production, lowers serum urate levels, and over time dissolves urate crystal deposits (tophi) in joints and soft tissues.

Unlike Allopurinol (a purine-based XO inhibitor), Febuxostat is a non-purine inhibitor with a different chemical structure, making it an important alternative for patients intolerant to or failing Allopurinol therapy.

In Kenya, gout is an increasingly prevalent condition driven by dietary changes, obesity, hypertension, and diuretic use. Febo-G 40mg is used for long-term urate-lowering therapy (ULT) in patients with confirmed hyperuricaemia and gout to reduce the frequency of acute attacks, prevent joint damage, and resolve tophi.

It is not used to treat an acute gout attack; anti-inflammatory prophylaxis (NSAIDs, colchicine) is required alongside initiation of ULT.

Starting Dose

40mg once daily. May be increased to 80mg daily after 2–4 weeks if serum urate remains > 6 mg/dL (360 µmol/L).

With or Without Food

May be taken with or without food. Take at the same time each day.

Do Not Start During Acute Attack

Do not initiate Febuxostat during an acute gout flare; wait until the attack fully resolves.

Anti-inflammatory Prophylaxis

Initiation of ULT can trigger gout flares. Co-prescribe colchicine 0.5mg daily or low-dose NSAID for at least 6 months when starting.

Duration

Long-term continuous therapy. Stopping leads to urate levels rising and gout returning. Do not stop without medical advice.

Monitoring

Check serum urate at 2–4 weeks to assess response. Aim for target serum urate < 6 mg/dL (360 µmol/L) or < 5 mg/dL (300 µmol/L) in tophaceous gout.

Common Side Effects

·       Acute gout flares in the first weeks of therapy (due to urate crystal mobilisation from tissues)

·       Nausea

·       Headache

·       Elevated liver enzymes (transient)

Uncommon Side Effects

·       Diarrhoea

·       Rash

·       Dizziness

·       Oedema

Serious Side Effects, Seek Immediate Medical Attention

·       Serious cardiovascular events: In the CARES trial, Febuxostat was associated with higher cardiovascular mortality than Allopurinol in patients with established CVD; a black box warning exists in some countries

·       Severe hypersensitivity reactions including Stevens-Johnson Syndrome (rare)

·       Hepatotoxicity (monitor LFTs)

·       Severe rash, discontinue immediately if severe rash develops

·       CARDIOVASCULAR RISK: The CARES trial identified a potential increased risk of cardiovascular death with Febuxostat versus Allopurinol in patients with established heart disease or stroke; use with caution in patients with known CVD and consider Allopurinol first.

·       GOUT FLARES ON INITIATION: Always prescribe anti-inflammatory prophylaxis (colchicine or NSAID) when starting Febuxostat; flares commonly occur in the first 6 months as urate crystals dissolve.

·       LIVER: Monitor liver function tests at baseline and periodically. Discontinue if significant LFT elevation occurs.

·       AZATHIOPRINE / 6-MP: ABSOLUTELY CONTRAINDICATED; co-administration causes severe, potentially fatal toxicity of immunosuppressive agents.

·       ACUTE ATTACK: Febuxostat is NOT a treatment for an acute gout attack; use colchicine or NSAIDs for acute management.

Azathioprine / 6-Mercaptopurine: ABSOLUTELY CONTRAINDICATED, XO inhibition dramatically increases levels of these drugs, causing potentially fatal bone marrow suppression.

Theophylline: CONTRAINDICATED, XO inhibition increases theophylline levels, risk of theophylline toxicity.

Didanosine (ddI, antiviral): XO inhibition increases didanosine levels; avoid or dose-reduce didanosine.

Warfarin: May interact; monitor INR.

Colchicine / NSAIDs: Used concurrently as prophylaxis during ULT initiation; monitor for toxicity, especially colchicine with renal impairment.

·       Store below 25°C in a cool, dry place.

·       Protect from moisture and light.

·       Keep in original blister packaging.

·       Keep out of reach of children.

Febo-G 40mg is available in Kenya with a pharmacist's recommendation or doctor's prescription. For patients with cardiovascular disease or those on multiple medications, a formal prescription and medical supervision are strongly recommended. Available at Pharmily.

Febo-G (Febuxostat 40mg) is a non-purine XO inhibitor, a clinically important alternative to Allopurinol for patients with Allopurinol intolerance or inadequate response. The absolute contraindication with azathioprine, 6-mercaptopurine, and theophylline is critical; screen the patient's full medication list before dispensing.

The CARES trial cardiovascular mortality signal means Febuxostat should be used with extra caution (or Allopurinol preferred) in patients with established ischaemic heart disease, stroke, or congestive heart failure.

Anti-inflammatory prophylaxis (colchicine 0.5mg OD or low-dose NSAID) is mandatory for at least the first 6 months of ULT initiation; confirm this is co-prescribed. Counsel clearly that Febuxostat is for long-term urate lowering, not acute attack treatment.

Urate target monitoring (serum uric acid < 6 mg/dL) at 2–4 weeks guides dose titration from 40mg to 80mg. Liver function should be monitored at baseline and periodically during therapy.

Q1: What is Febo-G used for?

A: Febo-G (Febuxostat) is used for long-term management of gout, it lowers uric acid levels in the blood to prevent gout attacks, dissolve urate crystal deposits (tophi), and protect joints from damage.

Q2: Will Febo-G stop a gout attack that is already happening?

A: No. Febo-G is not a treatment for an acute gout attack. Use colchicine or an anti-inflammatory (as directed by your doctor) for an active attack. Continue Febo-G throughout.

Q3: Why do I get gout flares when I first start Febo-G?

A: When Febo-G starts dissolving urate crystal deposits in your joints, this can temporarily trigger inflammation and pain. This is expected and does not mean the medicine is not working. Your doctor will prescribe anti-inflammatory prophylaxis to manage this.

Q4: How is Febo-G different from Allopurinol?

A: Both lower uric acid by inhibiting xanthine oxidase, but Febuxostat has a different chemical structure (non-purine), making it an important alternative for patients who cannot tolerate Allopurinol. Allopurinol may still be preferred in patients with heart disease.

Q5: How much water should I drink while on Febo-G?

A: Aim for at least 2 litres of water daily to help your kidneys excrete uric acid and reduce the risk of urate kidney stones.