A gout patient sent me a private message and said that he had been taking benzbromarone to lower uric acid. Last month, he discovered kidney stones, so he switched to febuxostat. After taking it for a month, he felt heart discomfort and slight palpitation.

explains it all at once: How should you choose among the three uric acid-lowering drugs?

Li Qing, TEDA Hospital of Tianjin University

A gout patient messaged me privately, saying that he had been using benzbromarone to lower uric acid. Last month, he found kidney stones , so he switched to febuxostat and took one. Yue felt uncomfortable with her heart and was slightly flustered. I heard that febuxostat can harm the heart. Is this a problem with febuxostat? What should I do next?

There are currently three uric acid-lowering drugs on the market: allopurinol , febuxostat and benzbromarone. Allopurinol is also unsafe, and exfoliative dermatitis caused by allergies has a high mortality rate. If he was as worried about the side effects of medicines, he would not dare to use any of the three medicines.

How to choose uric acid-lowering drugs? I will tell you everything today.

First of all, although the three drugs have different mechanisms for lowering uric acid, their efficacy is similar. Just choose one. What affects the choice is not the effect but the safety.

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The incidence of allergic reactions to allopurinol is higher among Han, Korean, and Thai people. Taiwanese guidelines require before using this drug. Genetic testing is , so many doctors stay away from allopurinol and are unwilling to choose it.

Benzbromarone promotes the excretion of uric acid from the urine. High uric acid content in the urine can easily form uric acid kidney stones. But our common kidney stones are calcium oxalate stones , so if you have kidney stones, you may not be able to choose benzbromarone. Just drink more water after taking the medicine.

After renal function decline, it is best to choose febuxostat.

Let me talk about the cardiovascular safety of febuxostat.

published the results of a study in 2018, which found that febuxostat has a higher risk of cardiovascular death than allopurinol. So in 2019, FDA gave febuxostat a black box warning, but also pointed out that patients should not take it on their own. Discontinue medication to prevent gout attacks or worsening.

The subjects of this study were white people, and the dosage of febuxostat was 80 mg per day. Later, the results of another study were released and found no difference in the safety profile of febuxostat and allopurinol, but warnings were issued.

Later, the results of two large-scale clinical studies in Japan and Taiwan were released. The subjects were yellow people, and the dosage was 40 mg per day. No difference in cardiovascular safety between febuxostat and allopurinol was found.

Global data from the World Health Organization show that there are regional differences in the adverse reactions of febuxostat and allopurinol. The hypersensitivity reaction (exfoliative dermatitis) of allopurinol in Asian populations is significantly higher than that of febuxostat but not of febuxostat. There is no significant difference in cardiovascular safety compared with , allopurinol, .

However, my country’s guidelines recommend that the dosage of febuxostat is 40mg instead of 80mg, so it is safe.

The American guideline recommends allopurinol and febuxostat as uric acid-lowering drugs, but not bromarone; my country recommends all three drugs.

explained the patient’s problem at the beginning. His so-called “cardiac reaction” is a psychological effect. If febuxostat’s side effects are so severe that heart damage occurs within a month, then the FDA will not warn but directly kick him out. .

In fact, many people pay too much attention to the side effects of drugs and ignore their efficacy. Everyone should think about a question: Are the side effects of drugs more serious, or the disease more harmful?

If you would rather suffer the repeated torture of gout than bear the side effects of urate-lowering drugs, you don’t need to use urate-lowering drugs; if you can accept the kidney damage caused by long-term high uric acid and are unwilling to bear the side effects of urate-lowering drugs, you can also No need for uric acid-lowering drugs.