Can taking febuxostat cause kidney stones if I have had gout and kidney stones with high uric acid? Do I need to stop taking it if it causes kidney stones?

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The drug that triggers uric acid kidney stones is benzbromarone, febuxostat does not trigger kidney stones.

Uric acid-lowering drugs currently in clinical use include two broad categories: reducing uric acid production and promoting uric acid excretion from the kidneys.

1. Inhibit uric acid synthesis:

Of the factors that contribute to the production of uric acid, 20% comes from the intake of high-purine foods, and 80% comes from the breakdown and metabolism of one's own cells. In other words, dietary factors only account for a very small part of the cause of hyperuricemia, so most people can not control blood uric acid levels up to standard simply by dietary control.

Commonly used drugs that inhibit uric acid synthesis are xanthine oxidase inhibitors, including allopurinol and febuxostat.

(1), Allopurinol: adult initial dose of 50 ~ 100mg / day, the maximum dose of 600mg / day. Patients with renal insufficiency should reduce the dosage, and the dosage is 50-100mg/d when the glomerular filtration rate is ≤60ml/min, and should be prohibited when the glomerular filtration rate is ≤30ml/min.

Allopurinol can cause skin sensitization and hepatic and renal impairment, and in severe cases, exfoliative dermatitis can occur. Exfoliative dermatitis is a lethal hypersensitivity reaction, often occurring in HLA-B*5801 gene positive people, while the application of thiazide diuretics and renal insufficiency is also prone to occur. HLA-B*5801 gene in the Han Chinese, Koreans, Thais, the rate of positivity is significantly higher than Caucasian people, it is recommended to take allopurinol treatment before the screening of the gene, the positive is prohibited.

(2), Febuxostat: initial dose 20-40mg/day, maximum dose 80mg/day. It is safe for kidney, no dosage reduction is needed for mild to moderate renal insufficiency, and it is used with caution in severe renal insufficiency (glomerular filtration rate ≤30ml/min). Adverse reactions include hepatic impairment, nausea, and rash.

2. Drugs that increase uric acid excretion:

Benzbromarone: Adults starting dose 25 to 50 mg/day, maximum dose 100 mg/day, after breakfast. Safe for kidneys, 50mg/day is recommended for glomerular filtration rates of 20-60 ml/min, and is contraindicated for glomerular filtration rates <20 ml/min, or in patients with uric acid nephrolithiasis. Adverse reactions include gastrointestinal upset, diarrhea, rash and hepatic impairment.

Benzbromarone promotes uric acid excretion, urinary uric acid concentration increased significantly, uric acid in the renal tubule deposition is easy to form uric acid kidney stones. Therefore, patients with uric acid kidney stones are prohibited from using benzbromarone to lower uric acid.

According to statistics, the vast majority of common kidney stones are calcium oxalate stones, and uric acid kidney stones are less than 20%, so there is no need to panic about benzbromarone for kidney stone patients.

Solution: Take Benzbromarone and usually drink plenty of water to dilute the urine, or take sodium bicarbonate tablets (baking soda tablets) at the same time to alkalize the urine and reduce the production of uric acid kidney stones.

At present, the mechanism of clinical uric acid lowering drugs mainly includes inhibition of uric acid synthesis and promotion of uric acid excretion, which inhibits the synthesis of uric acid is mainly through the inhibition of xanthine oxidase activity, reduce uric acid synthesis, this type of drugs include allopurinol, febuxostat, etc.; and promote uric acid excretion of the mechanism of drugs through the inhibition of renal tubular uric acid transporter protein-1, inhibition of renal tubular uric acid reabsorption and so on, two to promote the excretion of uric acid The most common drug used clinically to reduce blood uric acid levels is benzbromarone.

Febuxostat is a 2-arylthiazole derivative, which is a xanthine oxidase inhibitor that reduces serum uric acid concentration by inhibiting uric acid synthesis and is used clinically for gout, gouty arthritis, gout in the elderly, hyperuricemia, pseudogouty arthritis, gouty stones, and hereditary hyperuricemia. Febuxostat is mainly cleared through the liver, and no dose adjustment is required in mild to moderate renal insufficiency, i.e., G1-3 patients. Adverse effects of febuxostat are mainly liver function impairment, cardiovascular system, blood system abnormalities, gastrointestinal reactions such as nausea and skin rash, etc. It does not cause gout stones. However, in the initial stage of treatment, the mobilization of urate deposited in the tissues due to changes in blood uric acid levels may cause a gouty attack. If an attack of gout is triggered, there is no need to discontinue febuxostat. Of course, in order to prevent gout from being triggered in the early stages of febuxostat treatment, NSAIDs or colchicine can be taken at the same time.

Finally, it must be reminded that the use of febuxostat is contraindicated in patients undergoing treatment with azathioprine or mercaptopurine because febuxostat is a xanthine oxidase (XO) inhibitor and azathioprine and mercaptopurine are metabolized by XO, so that febuxostat's inhibition of XO could potentially trigger an increase in the plasma concentration of the above drugs and thus toxicity.

The above is only a personal opinion, not as a basis for the use of medication, please use medication under the guidance of a physician or pharmacist, any questions or views are welcome to leave a comment at the bottom of the article.

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

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Gout, please be sure to rheumatology clinic, specializing in the disease, only rheumatologists will be gout-related drugs and the role of potential side effects of the study thoroughly, in order to know what is up to the standard of treatment.

Generally speaking, kidney stones due to gout are caused by urate crystals, therefore, taking uric acid-lowering drugs must be used regularly for a long time. When you have kidney stones, you usually do not choose benzbromarone, but choose febuxostat or allopurinol. It is extremely unlikely that Febuxostat will cause a recurrence of gouty stones, so when kidney stones are caused by gout and you find that your once disappeared kidney stones have reappeared while you are taking Febuxostat, then Febuxostat will still have to be used, unless you develop more serious liver and heart muscle damage. To analyze the cause, it may be that you are drinking too little water, you need to drink more water every day (more than 2000ml) with some lemon.

If you have gout stones in your kidneys, you can decoct moneywort water and drink it. The Golden Dog Turbulent Tea, announced by Prof. Leap Moon in his headline, is more helpful for people who have kidney stones due to gout.

Fibrox it does not cause kidney stones, its side effects focus on the cardiovascular system, for patients with kidney stones need to be prohibited should be Benzbromarone this drug, in addition to patients with chronic renal insufficiency and then according to the situation to the appropriate choice.

There are two main classes of drugs that are currently used in clinical practice to lower uric acid levels.

The first category is medications that inhibit the production of uric acid in the body like allopurinol and febuxostat for example.

The second group of drugs are those that promote uric acid excretion, e.g., benzbromarone.

Specifically which drugs should be selected, generally by the clinician to decide, according to some of the characteristics of the patient's condition as well as complications to make a choice, it is recommended that you do not arbitrarily take their own drugs.

For questions about hyperuricemia as well as gout, please feel free to leave a comment for Dr. Chen.

Thanks for the invitation to answer this question.

Febuxostat is a uric acid lowering medication that generally does not cause stones. But gout caused by high uric acid is just as likely to cause stones.

Kidney stones are affected by so many factors that it is practically difficult for us to determine what it is due to. At present, the most effective way is to do stone composition analysis and urine metabolism assessment. Through these tests, we can understand the composition of the stones and the concentration of various stone triggering factors and ions in the urine, so as to indirectly determine the cause of the stones. We encounter many patients with uric acid stones who do not have high uric acid. And many patients with very high uric acid stones do not have uric acid stones. So it's still a difficult question to answer.

It is important to focus on a combination of prevention of kidney stones. Without knowing the composition of the stones and the results of the metabolic evaluation of the urine, the most effective method of prevention is to drink more water and exercise. And it is not something that can be solved simply by banning which foods or which medications!

I hope my answer helps you!

Feibu is a uric acid-lowering drug, where uric acid-lowering drugs have side effects, especially on the liver and kidneys, it is recommended to do a genetic test and then see what uric acid-lowering drugs to use, and eat uric acid-lowering drugs initially easy to increase uric acid, not good for kidney stones, so start with a small dosage, slowly add. Once triggered, it is definitely time to stop taking it. And if the uric acid is too high, you must drink more water, control your diet, eat less animal liver, seafood, less alcohol!