Febuxostat is a selective xanthine oxidase inhibitor mainly used to treat hyperuricemia and related diseases. Its use requires special attention to cardiovascular risk, liver function monitoring, and adjustment for special populations. The following provides a detailed explanation from two aspects: indications and medication precautions.

1. Indications

(1) Chronic gout: suitable for long-term treatment of hyperuricemia in gout patients, especially those who are intolerant to allopurinol or have poor efficacy.

(2) Asymptomatic hyperuricemia: can be used for patients with sustained elevated uric acid levels (>8mg/dL) and a history of gouty or urinary tract stones.

2. Medication precautions

(1) Cardiovascular monitoring: Early treatment may increase the risk of cardiovascular events, and patients with coronary heart disease need to undergo regular evaluation of electrocardiogram and clinical symptoms.

(2) Liver function management: ALT should be monitored every 2-4 weeks before medication and during treatment. Child Pugh grade C should be avoided, and grade B should be reduced by 50%.

(3) Gout attack management: Initial treatment may trigger acute attacks, and it is recommended to use colchicine or NSAIDs in combination for 6 months for prevention.

(4) Allergy reaction prevention: If rash or vascular edema occurs, the medication should be stopped immediately. Severe skin reactions require permanent termination of treatment.

(5) Special population: contraindicated during pregnancy, dosage adjustment is necessary for those with impaired kidney function, but patients with end-stage renal disease should be alert to the risk of accumulation.