Is a uric acid level of 7.35 mg/dl acceptable for a patient taking Febuxostat (febuxostat) 80mg once daily?

A uric acid level of 7.35 mg/dL is NOT acceptable on Febuxostat 80mg—the dose should be increased to achieve target levels below 6 mg/dL.

Target Uric Acid Levels

The therapeutic target for all gout patients on urate-lowering therapy is a serum uric acid level below 6 mg/dL (360 μmol/L), which must be maintained lifelong. 1 Your current level of 7.35 mg/dL exceeds this target and indicates inadequate disease control.

• For patients with severe gout (tophi, chronic arthropathy, or frequent attacks), an even lower target of <5 mg/dL is recommended until complete crystal dissolution occurs, after which the target can be relaxed to <6 mg/dL 1
• Maintaining uric acid above 6 mg/dL allows continued crystal deposition and prevents dissolution of existing crystals 1

Dose Adjustment Strategy

Febuxostat 80 mg is the standard effective dose, but you have not yet achieved the therapeutic target. The evidence shows that:

• Febuxostat 80 mg achieves target uric acid <6 mg/dL in 67% of patients, meaning approximately one-third require further intervention 2
• The maximum FDA-approved dose is 80 mg daily, though doses up to 120 mg were studied in clinical trials and showed greater uric acid reduction 2
• All urate-lowering therapy should be titrated upward until the target is reached 1

Recommended Next Steps:

1. Verify medication adherence before making changes 1
2. Consider increasing to Febuxostat 120 mg daily (off-label but studied dose) if available in your region 2
3. Add a uricosuric agent (probenecid or benzbromarone) to Febuxostat 80 mg if dose escalation is not possible 1, 3
4. Recheck serum uric acid in 2-5 weeks after any dose adjustment 2, 4

Critical Monitoring Requirements

• Measure serum uric acid every 2-5 weeks during dose titration 4, 5
• Once target <6 mg/dL is achieved, monitor every 6 months to assess adherence 2
• Continue flare prophylaxis (colchicine 0.5-1 mg daily or low-dose NSAID) throughout dose adjustments and for at least 3-6 months after achieving target 1, 2

Important Considerations

Febuxostat does not require dose adjustment for renal impairment, making it particularly advantageous over allopurinol in patients with chronic kidney disease 4, 6 However, be aware that febuxostat carries an FDA black box warning regarding cardiovascular risk—if you have a history of cardiovascular disease, discuss switching to alternative therapy with your physician 2, 4

Achieving and maintaining uric acid <6 mg/dL results in progressive decrease in gout flare risk to approximately 5% at 12 months and near zero at 32 months. 2 Conversely, remaining at 7.35 mg/dL perpetuates crystal deposition and ongoing disease activity.