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Febuxostat cardiovascular caution — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsFebuxostat cardiovascular cautionGPhC CRA

A 68-year-old with gout and a previous myocardial infarction needs urate-lowering therapy. He has never taken allopurinol, renal function permits cautious titration and there is no contraindication to it. Which initial strategy best reflects UK guidance?

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Correct answer: E — Use allopurinol, titrated to target, with flare prophylaxis during initiation

NICE and the updated MHRA advice support allopurinol as first-line urate-lowering therapy in people with major cardiovascular disease. Treatment is started cautiously, titrated to urate target and accompanied by flare prophylaxis when indicated. Febuxostat is not absolutely prohibited but should be used cautiously when it is needed; combining two xanthine-oxidase inhibitors or using aspirin as a cardiovascular antidote is unsuitable.

Reference: MHRA Drug Safety Update, Febuxostat and major cardiovascular disease: https://www.gov.uk/drug-safety-update/febuxostat-updated-advice-for-the-treatment-of-patients-with-a-history-of-major-cardiovascular-disease