Adenuric

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Adenuric on Prescriptsy

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Important medical information

The information on this page does not replace a diagnosis or personalised advice from a doctor. Adenuric is a prescription-only medicine (POM) that affects uric acid metabolism and carries specific safety considerations, particularly regarding cardiovascular risk and liver function.

• Treatment with Adenuric should be prescribed by a doctor who has assessed your cardiovascular risk profile and overall health.
• If you develop chest pain, sudden breathlessness, severe skin reactions with blistering, or yellowing of the skin or eyes, stop taking Adenuric and seek emergency medical attention by calling 999.
• This page provides general guidance only. Always follow the instructions given by your doctor and read the Patient Information Leaflet supplied with your medicine.

What is Adenuric and how does it work?

Adenuric is the brand name for a medicine containing the active substance febuxostat .

Febuxostat belongs to a class of drugs called xanthine oxidase inhibitors, which work by reducing the production of uric acid in the body.

Adenuric is licensed in the United Kingdom for the treatment of chronic hyperuricaemia in conditions where urate deposition has already occurred, including a history of, or the presence of, tophus (solid urate crystal deposits) or gouty arthritis.

Uric acid is a waste product formed when the body breaks down purines, substances found naturally in the body and in certain foods.

Normally, uric acid dissolves in the blood, passes through the kidneys and is excreted in urine.

When the body produces too much uric acid or the kidneys do not eliminate enough, levels in the blood rise.

This condition, known as hyperuricaemia, can lead to the formation of sharp urate crystals in joints and surrounding tissues, causing the intense pain and inflammation of gout.

Febuxostat works by inhibiting xanthine oxidase, the enzyme responsible for the final steps in uric acid production.

By blocking this enzyme, less uric acid is produced, blood levels fall, and over time the existing crystal deposits gradually dissolve.

This process reduces the frequency of gout flares and prevents further joint damage, although it requires consistent, long-term treatment.

Understanding gout and hyperuricaemia

What is gout?

Gout is a common and intensely painful form of inflammatory arthritis.

It is caused by the deposition of monosodium urate crystals in joints, most classically in the big toe (podagra), although any joint can be affected.

An acute gout attack typically comes on rapidly, often overnight, with severe pain, swelling, redness and warmth in the affected joint.

Without treatment, attacks usually resolve within one to two weeks but tend to recur with increasing frequency over time.

Chronic gout and tophi

If hyperuricaemia is left untreated over many years, urate crystals can accumulate in and around joints, forming lumps called tophi.

These can cause chronic joint pain, stiffness and deformity. Urate deposits can also occur in the kidneys, contributing to kidney stones.

Effective long-term urate-lowering therapy with medicines like Adenuric aims to dissolve these deposits and prevent further damage.

Who gets gout?

Gout affects approximately 2.5 per cent of the adult population in the UK, making it one of the most common inflammatory joint conditions.

It is more common in men than women, typically developing from the age of 30 onwards in men and after the menopause in women.

Risk factors include family history, obesity, high alcohol intake (particularly beer and spirits), diets rich in purines, kidney disease, high blood pressure, and certain medications such as diuretics.

When is Adenuric prescribed?

Position in treatment guidelines

In UK clinical practice, allopurinol is the first-line urate-lowering therapy for most patients with gout.

Adenuric is typically reserved for patients who cannot tolerate allopurinol (for example due to hypersensitivity or side effects), those in whom allopurinol does not reduce uric acid to target levels despite appropriate dose escalation, or those with contraindications to allopurinol.

NICE guidance and the British Society for Rheumatology (BSR) both position febuxostat as a second-line option in most clinical scenarios.

Cardiovascular risk assessment

Before prescribing Adenuric, your doctor should assess your cardiovascular risk.

The European Medicines Agency (EMA) and the MHRA have issued advice that febuxostat should not be used in patients with pre-existing major cardiovascular disease unless no other therapy is appropriate.

This is based on data from clinical trials, most notably the CARES trial, which observed higher cardiovascular and all-cause mortality in the febuxostat group compared with allopurinol among patients with established cardiovascular conditions.

A subsequent European trial (FAST) did not confirm these findings in a broader population, but caution remains warranted.

How to take Adenuric

Adenuric is available as film-coated tablets in strengths of 80 mg and 120 mg.

The usual starting dose is 80 mg once daily, taken at any time of day with or without food.

If your uric acid level has not reached the target after two to four weeks, your doctor may increase the dose to 120 mg once daily.

Consistency is important. Try to take Adenuric at the same time each day.

It is a long-term treatment, and stopping the medicine will cause uric acid levels to rise again, potentially triggering gout flares.

Even when you feel well and are free from gout attacks, continue taking the medicine as prescribed.

Managing gout flares during early treatment

It is common and expected for gout flares to increase during the first weeks and months after starting Adenuric.

This happens because as uric acid levels drop, the existing urate crystal deposits in joints begin to dissolve. The process of dissolving can temporarily trigger inflammation and flares.

This does not mean the medicine is making your condition worse; it is actually a sign that the treatment is working.

To manage this, your doctor will usually prescribe prophylactic treatment for at least six months when starting Adenuric.

This is typically low-dose colchicine or an anti-inflammatory drug such as naproxen.

If a flare occurs, continue taking Adenuric and treat the flare with the medicine your doctor has provided.

Do not stop Adenuric because of a flare, as this can worsen the long-term outlook.

Side effects of Adenuric

The most frequently reported side effects include gout flares (particularly early in treatment), abnormal liver function tests, headache, diarrhoea, nausea, rash and swelling.

Liver enzyme elevations are usually mild and transient but should be monitored with blood tests.

Your doctor will typically check liver function before starting treatment, during the first few months, and periodically thereafter.

Less common side effects include dizziness, taste disturbance, fatigue, joint and muscle pain, blurred vision and decreased libido.

Rare but serious side effects include hepatitis, pancreatitis, rhabdomyolysis (serious muscle breakdown) and severe skin reactions such as Stevens-Johnson syndrome. Severe allergic reactions are very rare.

The cardiovascular safety profile of febuxostat remains an important consideration.

Patients and doctors should weigh the benefits of urate lowering against the potential cardiovascular risks, particularly in those with pre-existing heart disease.

Regular follow-up and reporting of any cardiovascular symptoms is essential.

Adenuric compared with allopurinol

Both Adenuric (febuxostat) and allopurinol are xanthine oxidase inhibitors with the same fundamental mechanism of action. They differ in their chemical structure, metabolism and some aspects of their clinical profiles.

Allopurinol is a purine analogue and has been available for over 50 years. It is well established, inexpensive and recommended as first-line therapy.

The dose can be titrated up to 900 mg per day, although many patients are undertreated at lower doses.

Allopurinol requires dose reduction in patients with significant kidney disease, and rare but serious hypersensitivity reactions (allopurinol hypersensitivity syndrome) can occur, particularly in patients of Han Chinese, Thai or Korean ancestry who carry the HLA-B*5801 allele.

Febuxostat is a non-purine compound with higher potency at standard doses.

Clinical trials have shown that febuxostat 80 mg and 120 mg are more effective than allopurinol 300 mg at lowering serum urate, although the comparison is less clear when allopurinol is properly dose-escalated.

Febuxostat does not require the same degree of dose adjustment for renal impairment.

However, the cardiovascular safety concerns and higher cost position it as a second-line therapy in most cases.

The choice between these medicines should be made by your doctor based on your individual circumstances, including kidney function, cardiovascular history, tolerance of previous treatments and target uric acid levels.

Lifestyle measures for managing gout

Medicines like Adenuric are most effective when combined with appropriate dietary and lifestyle modifications. While diet alone is rarely sufficient to control gout, the following measures can help reduce uric acid levels and the frequency of flares.

• Limit alcohol intake, especially beer and spirits, which increase uric acid production and reduce its excretion.
• Reduce consumption of purine-rich foods such as red meat, organ meats (liver, kidneys), shellfish, anchovies and sardines.
• Avoid sugary drinks and foods containing high-fructose corn syrup, which can raise uric acid levels.
• Stay well hydrated by drinking plenty of water throughout the day.
• Maintain a healthy weight. If you are overweight, gradual weight loss can help lower uric acid levels, but avoid crash diets, which can paradoxically trigger flares.
• Include low-fat dairy products in your diet, as these may have a protective effect.
• Take regular moderate exercise, which supports overall cardiovascular and metabolic health.

Monitoring during treatment

If you are taking Adenuric, your doctor will arrange regular monitoring.

This typically includes blood tests to check serum uric acid levels (to assess whether the treatment target is being met), liver function tests (particularly during the first year), and assessment of kidney function.

Your doctor will also ask about symptoms of gout flares, side effects and cardiovascular health at each review.

The treatment target for serum uric acid is generally below 360 micromol per litre for most patients, and below 300 micromol per litre for those with severe gout (frequent flares, tophi, chronic gouty arthritis or urate arthropathy).

Reaching and maintaining these targets reduces crystal burden over time and prevents further joint damage.

Adenuric and the NHS

Adenuric is available on NHS prescription in the UK. Generic febuxostat tablets are also becoming available, which may reduce costs over time.

The standard NHS prescription charge in England is nine pounds and ninety pence per item. Prescription charges do not apply in Scotland, Wales or Northern Ireland.

If you pay for prescriptions and are on long-term treatment, a pre-payment certificate may be more economical.

NICE technology appraisal TA164 recommends febuxostat as an option for managing hyperuricaemia in patients with gout who are intolerant of allopurinol or for whom allopurinol is contraindicated. This recommendation supports NHS prescribing of Adenuric in the appropriate clinical context.

When to seek medical advice

Contact your GP or call NHS 111 if you are experiencing persistent or worsening gout flares despite treatment, if you develop new symptoms that concern you, or if you have questions about your medication.

Seek emergency help by calling 999 if you develop chest pain, sudden breathlessness, signs of a stroke, a severe widespread skin reaction, or symptoms of liver failure such as yellowing of the skin and eyes with dark urine.

Sources and further reading

• Summary of Product Characteristics, Adenuric, EMC (medicines.org.uk)
• British National Formulary, Febuxostat, bnf.nice.org.uk
• NICE Technology Appraisal TA164, Febuxostat for the management of hyperuricaemia in people with gout, nice.org.uk
• NICE Clinical Knowledge Summaries, Gout, cks.nice.org.uk
• British Society for Rheumatology, Guidelines for the management of gout, rheumatology.org.uk
• NHS, Gout, nhs.uk
• MHRA Yellow Card Scheme, yellowcard.mhra.gov.uk