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Febuxostat cardiovascular caution — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsFebuxostat cardiovascular cautionGPhC CRA

A 64-year-old man with gout and previous myocardial infarction asks why his GP prefers allopurinol rather than febuxostat. He has normal renal function and no previous allopurinol reaction. What is the most appropriate alternative?

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Correct answer: C — Allopurinol with low-dose initiation and titration if suitable

Allopurinol is generally first-line urate-lowering therapy when suitable. Febuxostat has cardiovascular cautions, so it may be less suitable in someone with previous myocardial infarction unless allopurinol is inappropriate. Treatment should be titrated to urate target and flare prophylaxis considered.

Reference: BNF; NICE CKS