From the Research
Febuxostat should not be discontinued in a patient with liver cirrhosis without careful consideration of the risk-benefit ratio and alternative treatment options. When managing patients with liver cirrhosis, it is crucial to balance the risks of febuxostat, which is primarily metabolized in the liver, against its benefits in controlling uric acid levels and preventing gout symptoms. According to a study published in 2019 1, febuxostat has been found to have a lower incidence of hepatotoxicity compared to allopurinol in patients with gout and fatty liver disease, suggesting that it may be a safer option for patients with liver impairment.
Key considerations in deciding whether to continue, adjust, or discontinue febuxostat in a patient with cirrhosis include:
- Assessing the severity of liver impairment through liver function tests and the Child-Pugh classification
- Evaluating the patient's uric acid levels and gout symptoms
- Considering alternative urate-lowering therapies, such as dose-adjusted allopurinol, if febuxostat is not tolerated
- Regular monitoring of liver function tests if continuing febuxostat in a patient with cirrhosis
It is also important to note that while exercise has been shown to have potential benefits in patients with cirrhosis, including improved endurance and functional outcome measures 2, this does not directly impact the decision to discontinue febuxostat. The primary concern remains the management of uric acid levels and the prevention of gout symptoms while minimizing the risk of hepatotoxicity.