Uloric is prescribed as either 40mg or 80mg per day according to the latest Uloric Prescribing Label.
Standard procedure is to start with a 40mg dose, then test after two weeks to see if 5mg/dL has been reached. If not, then increase to 80mg per day. Note that there is little room for half measures here. The label says “below 6mg/dL,” and this should normally be interpreted as 5. Anything between 5 and 6 might be acceptable in certain patients with other health issues, but the target for safe uric acid levels is 5mg/dL or lower.
Unfortunately, a GoutPal follower in the gout chatroom is struggling to achieve anywhere near this:
Uloric is generally safe, though some isolated concerns about liver problems prompt me to recommend that every gout patient on Uloric should have liver function and kidney function tests whenever they have uric acid tests. This should be at least once per year. I also recommend this for allopurinol.
As a new drug, Uloric has been subjected to extensive tests during its trial period. As part of these trials, it was determined:
ULORIC was studied in healthy subjects in doses up to 300 mg daily for seven days without evidence of dose-limiting toxicities.
Is 80mg Uloric always enough?
If allopurinol or Uloric is not achieving target uric acid levels, a rheumatologist should be consulted. This is a specialist case, beyond most doctors, and definitely beyond the scope of an Internet support service such as GoutPal.
A rheumatologist would normally consider either increasing the dose or supporting with other gout medicines to achieve a reasonable target. There are no general guidelines for this, as each case has to be considered on a personal basis, with complete medical history.
In an ideal world, gout patients would have liver function, kidney function, and 24-hour uric acid excretion rate tests before starting treatment to lower uric acid. As Uloric and allopurinol are generally safe and effective, these tests might not always be done. In most cases, they are not required.
In edge cases, such as this one where 80mg Uloric is not enough, the test results might be useful. Only a rheumatologist who has good gout knowledge can judge this. Your rheumatologist might take you off uric acid lowering medication to take the tests so that he has the full facts.
What happens next is really beyond GoutPal. This website cannot provide medical help, and you must see your own rheumatologist. I can however help you ask the right questions. In this case, the questions are:
- Uricosuric Support: can Uloric be supported with a uricosuric, such as probenecid, to assist with uric acid excretion?
- Off-label Dose Increase: can Uloric dose be increased beyond 80mg in view of the reported safety up to 300mg per day.
Please note that Uloric is a brand name for febuxostat, which is also sold under other names, including Adenuric. As a new drug, it is not available under it’s generic name of febuxostat. It is also sold as Atenurix in and around the Philippines. Interestingly, from the limited prescribing information I have seen, maximum dose of febuxostat sold as Atenurix is set at 120mg per day.
Have you been in a situation where standard uric acid lowering treatment has failed to achieve safe uric acid levels? Please share your experiences, and your rheumatologist’s advice in my gout forum my gout network, or in the gout chatroom.
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