FEBUXOSTAT by Lannett Company, Inc. / Sunshine Lake Pharma Co., Ltd. FEBUXOSTAT tablet

FEBUXOSTAT by

Drug Labeling and Warnings

FEBUXOSTAT by is a Prescription medication manufactured, distributed, or labeled by Lannett Company, Inc., Sunshine Lake Pharma Co., Ltd.. Drug facts, warnings, and ingredients follow.

Drug Details [pdf]

  • BOXED WARNING (What is this?)

    WARNING: CARDIOVASCULAR DEATH

    Gout patients with established cardiovascular (CV) disease treated with febuxostat tablets had a higher rate of CV death compared to those treated with allopurinol in a CV outcomes study [see Warnings and Precautions (5.1)] .

    Consider the risks and benefits of febuxostat tablets when deciding to prescribe or continue patients on febuxostat tablets. Febuxostat tablets should only be used in patients who have an inadequate response to a maximally titrated dose of allopurinol, who are intolerant to allopurinol, or for whom treatment with allopurinol is not advisable [see Indications and Usage (1)] .

  • 1 INDICATIONS AND USAGE

    Febuxostat tablet is a xanthine oxidase (XO) inhibitor indicated for the chronic management of hyperuricemia in adult patients with gout who have an inadequate response to a maximally titrated dose of allopurinol, who are intolerant to allopurinol, or for whom treatment with allopurinol is not advisable.

    Limitations of Use:

    Febuxostat tablets are not recommended for the treatment of asymptomatic hyperuricemia.

  • 2 DOSAGE AND ADMINISTRATION

    2.1 Recommended Dosage

    The recommended febuxostat tablets dosage is 40 mg or 80 mg once daily.

    The recommended starting dosage of febuxostat tablets is 40 mg once daily. For patients who do not achieve a serum uric acid (sUA) less than 6 mg/dL after two weeks, the recommended febuxostat tablets dosage is 80 mg once daily.

    Febuxostat tablets can be taken without regard to food or antacid use [see Clinical Pharmacology (12.3)].

    Concurrent prophylactic treatment with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended [ see Dosage and Administration (2.4)and Warnings and Precautions (5.2)].

    2.2 Dosage Recommendations in Patients with Renal Impairment and Hepatic Impairment

    The recommended dosage of febuxostat tablets is limited to 40 mg once daily in patients with severe renal impairment. No dose modification is necessary when administering febuxostat tablets in patients with mild or moderate renal impairment  [see Use in Specific Populations (8.6)and Clinical Pharmacology (12.3)] .

    No dosage modification is necessary in patients with mild to moderate hepatic impairment [see Use in Specific Populations (8.7)and Clinical Pharmacology (12.3)] .

    2.3 Serum Uric Acid Level Monitoring

    Testing for the target serum uric acid level of less than 6 mg/dL may be performed as early as two weeks after initiating febuxostat tablets therapy.

    2.4 Recommended Prophylaxis for Gout Flares

    Gout flares may occur after initiation of febuxostat tablets due to changing serum uric acid levels resulting in mobilization of urate from tissue deposits. Flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended upon initiation of febuxostat tablets. Prophylactic therapy may be beneficial for up to six months [see Clinical Studies (14.1)] .

    If a gout flare occurs during febuxostat tablets treatment, febuxostat tablets need not be discontinued. The gout flare should be managed concurrently, as appropriate for the individual patient [see Warnings and Precautions (5.2)] .

  • 3 DOSAGE FORMS AND STRENGTHS

    • 40 mg tablets, white or almost white round film-coated tablets, debossed with "C33" on one side and blank on the other side.
    • 80 mg tablets, white or almost white capsule-shaped film-coated tablets, debossed with "C32" on one side and blank on the other side.
  • 4 CONTRAINDICATIONS

    Febuxostat tablets are contraindicated in patients being treated with azathioprine or mercaptopurine [see Drug Interactions (7)] .

  • 5 WARNINGS AND PRECAUTIONS

    5.1 Cardiovascular Death

    In a cardiovascular (CV) outcome study, gout patients with established CV disease treated with febuxostat tablets had a higher rate of CV death compared to those treated with allopurinol. Sudden cardiac death was the most common cause of adjudicated CV deaths, 2.7% in the febuxostat tablets group (83 of 3,098) as compared to 1.8% in the allopurinol group (56 of 3,092). Febuxostat tablets were similar to allopurinol for nonfatal myocardial infarction (MI), nonfatal stroke and unstable angina with urgent coronary revascularization [see Clinical Studies (14.2)] .

    Because of the increased risk of CV death, febuxostat tablets should only be used in patients who have an inadequate response to a maximally titrated dose of allopurinol, who are intolerant to allopurinol, or for whom treatment with allopurinol is not advisable [see Indications and Usage(1)] .

    Consider the risks and benefits of febuxostat tablets when deciding to prescribe or continue patients on febuxostat tablets. Consider use of prophylactic low-dose aspirin therapy in patients with a history of CV disease. Monitor patients for the development of CV events. Inform patients about the symptoms of serious CV events and the steps to take if they occur.

    5.2 Gout Flares

    After initiation of febuxostat tablets, an increase in gout flares is frequently observed. This increase is due to reduction in serum uric acid levels, resulting in mobilization of urate from tissue deposits.

    In order to prevent gout flares when febuxostat tablets are initiated, concurrent prophylactic treatment with an NSAID or colchicine is recommended [see Dosage and Administration (2.4)].

    5.3 Hepatic Effects

    Cases of fatal and nonfatal hepatic failure in patients taking febuxostat tablets have been reported. During randomized controlled studies, transaminase elevations greater than three times the upper limit of normal (ULN) were observed (AST: 2%, 2%, and ALT: 3%, 2% in febuxostat tablets and allopurinol-treated patients, respectively). No dose-effect relationship for these transaminase elevations was noted [see Clinical Pharmacology (12.3)] .

    Obtain a liver test panel (serum alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase, and total bilirubin) as a baseline before initiating febuxostat tablets.

    Measure liver tests promptly in patients who report symptoms that may indicate liver injury, including fatigue, anorexia, right upper abdominal discomfort, dark urine or jaundice. In this clinical context, if the patient presents abnormal liver tests (ALT or AST greater than three times the upper limit of the reference range), interrupt febuxostat tablets treatment while investigating the probable cause. Permanently discontinue febuxostat tablets if liver injury is confirmed, and no alternate etiology can be found.

    Permanently discontinue febuxostat tablets in patients who have serum ALT or AST greater than three times the reference range with serum total bilirubin greater than two times the reference range without alternative etiologies because they are at risk for severe drug-induced liver injury. For patients with lesser elevations of serum ALT or bilirubin and with an alternate probable cause, treatment with febuxostat tablets can be used with close monitoring.

    5.4 Serious Skin Reactions

    Serious skin and hypersensitivity reactions, including Stevens-Johnson Syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS) and toxic epidermal necrolysis (TEN) have been reported postmarketing in patients taking febuxostat tablets. Discontinue febuxostat tablets if serious skin reactions are suspected [see Patient Counseling Information (17)]. Many of these patients had reported previous similar skin reactions to allopurinol. Febuxostat tablets should be used with close monitoring in these patients.

  • 6 ADVERSE REACTIONS

    The following serious adverse reactions are described elsewhere in the prescribing information:

    6.1 Clinical Trials Experience

    Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

    In Phase 2 and 3 clinical studies, a total of 2757 patients with hyperuricemia and gout were treated with febuxostat tablets 40 mg or 80 mg daily. For febuxostat tablets 40 mg, 559 patients were treated for ≥ 6 months. For febuxostat tablets 80 mg, 1377 patients were treated for ≥ 6 months, 674 patients were treated for ≥ 1 year and 515 patients were treated for ≥ 2 years. In the CARES study, a total of 3098 patients were treated with febuxostat tablets 40 mg or 80 mg daily; of these, 2155 patients were treated for ≥ 1 year and 1539 were treated for ≥ 2 years [see Clinical Studies (14.2)] .

    Most Common Adverse Reactions

    In three randomized, controlled clinical studies (Studies 1, 2 and 3), which were six to 12 months in duration, the following adverse reactions were reported by the treating physician as related to study drug. Table 1 summarizes adverse reactions reported at a rate of at least 1% in febuxostat tablets treatment groups and at least 0.5% greater than placebo.

    Table 1: Adverse Reactions Occurring in ≥ 1% of Patients Treated with febuxostat tablets and at Least 0.5% Greater than Seen in Patients Receiving Placebo in Controlled Studies
    Placebofebuxostat tabletsallopurinol *
    Adverse Reactions(N=134)40 mg daily
    (N=757)     		80 mg daily
    (N=1279)     		(N=1277)
  • * Of the patients who received allopurinol, 10 received 100 mg, 145 received 200 mg, and 1122 received 300 mg, based on level of renal impairment.
    		•
    Liver Function Abnormalities0.7%6.6%4.6%4.2%
    Nausea0.7%1.1%1.3%0.8%
    Arthralgia0%1.1%0.7%0.7%
    Rash0.7%0.5%1.6%1.6%

    The most common adverse reaction leading to discontinuation from therapy was liver function abnormalities in 1.8% of febuxostat tablets 40 mg, 1.2% of febuxostat tablets 80 mg, and in 0.9% of patients treated with allopurinol.

    In addition to the adverse reactions presented in Table 1, dizziness was reported in more than 1% of patients treated with febuxostat tablets although not at a rate more than 0.5% greater than placebo.

    In the CARES study, liver function abnormalities and diarrhea were reported in more than 1% of patients treated with febuxostat tablets, although not at a rate more than 0.5% greater than allopurinol.

    Less Common Adverse Reactions

    In clinical studies the following adverse reactions occurred in less than 1% of patients and in more than one subject treated with doses ranging from 40 mg to 240 mg of febuxostat tablets. This list also includes adverse reactions (less than 1% of patients) associated with organ systems from Warnings and Precautions.

    Blood and Lymphatic System Disorders:anemia, idiopathic thrombocytopenic purpura, leukocytosis/leukopenia, neutropenia, pancytopenia, splenomegaly, thrombocytopenia.

    Cardiac Disorders:angina pectoris, atrial fibrillation/flutter, cardiac murmur, ECG abnormal, palpitations, sinus bradycardia, tachycardia.

    Ear and Labyrinth Disorders:deafness, tinnitus, vertigo.

    Eye Disorders:vision blurred.

    Gastrointestinal Disorders:abdominal distention, abdominal pain, constipation, dry mouth, dyspepsia, flatulence, frequent stools, gastritis, gastroesophageal reflux disease, gastrointestinal discomfort, gingival pain,hematemesis, hyperchlorhydria, hematochezia, mouth ulceration, pancreatitis, peptic ulcer, vomiting.

    General Disorders and Administration Site Conditions:asthenia, chest pain/discomfort, edema, fatigue, feeling abnormal, gait disturbance, influenza-like symptoms, mass, pain, thirst.

    Hepatobiliary Disorders:cholelithiasis/cholecystitis, hepatic steatosis, hepatitis, hepatomegaly.

    Immune System Disorder:hypersensitivity.

    Infections and Infestations:herpes zoster.

    Procedural Complications:contusion.

    Metabolism and Nutrition Disorders:anorexia, appetite decreased/increased, dehydration, diabetes mellitus, hypercholesterolemia, hyperglycemia, hyperlipidemia, hypertriglyceridemia, hypokalemia, weight decreased/increased.

    Musculoskeletal and Connective Tissue Disorders:arthritis, joint stiffness, joint swelling, muscle spasms/twitching/tightness/weakness, musculoskeletal pain/stiffness, myalgia.

    Nervous System Disorders:altered taste, balance disorder, cerebrovascular accident, Guillain-Barré syndrome, headache, hemiparesis, hypoesthesia, hyposmia, lacunar infarction, lethargy, mental impairment, migraine, paresthesia, somnolence, transient ischemic attack, tremor.

    Psychiatric Disorders:agitation, anxiety, depression, insomnia, irritability, libido decreased, nervousness, panic attack, personality change.

    Renal and Urinary Disorders:hematuria, nephrolithiasis, pollakiuria, proteinuria, renal failure, renal insufficiency, urgency, incontinence.

    Reproductive System and Breast Changes:breast pain, erectile dysfunction, gynecomastia.

    Respiratory, Thoracic and Mediastinal Disorders:bronchitis, cough, dyspnea, epistaxis, nasal dryness, paranasal sinus hypersecretion, pharyngeal edema, respiratory tract congestion, sneezing, throat irritation, upper respiratory tract infection.

    Skin and Subcutaneous Tissue Disorders:alopecia ,angio-edema, dermatitis, dermographism, ecchymosis, eczema, hair color changes, hair growth abnormal, hyperhidrosis ,peeling skin, petechiae, photosensitivity, pruritus, purpura, skin discoloration/altered pigmentation, skin lesion, skin odor abnormal, urticaria.

    Vascular Disorders:flushing, hot flush, hypertension, hypotension.

    Laboratory Parameters:activated partial thromboplastin time prolonged, creatine increased, bicarbonate decreased, sodium increased, EEG abnormal, glucose increased, cholesterol increased, triglycerides increased, amylase increased, potassium increased, TSH increased, platelet count decreased, hematocrit decreased, hemoglobin decreased, MCV increased, RBC decreased, creatinine increased, blood urea increased, BUN/creatinine ratio increased, creatine phosphokinase (CPK) increased, alkaline phosphatase increased, LDH increased, PSA increased, urine output increased/decreased, lymphocyte count decreased, neutrophil count decreased, WBC increased/decreased, coagulation test abnormal, low density lipoprotein (LDL) increased, prothrombin time prolonged, urinary casts, urine positive for white blood cells and protein.

    6.2 Postmarketing Experience

    The following adverse reactions have been identified during post approval use of febuxostat tablets. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

    Blood and Lymphatic System Disorders:agranulocytosis, eosinophilia.

    Hepatobiliary Disorders:hepatic failure (some fatal), jaundice, serious cases of abnormal liver function test results, liver disorder.

    Immune System Disorders:anaphylaxis, anaphylactic reaction.

    Musculoskeletal and Connective Tissue Disorders:rhabdomyolysis.

    Psychiatric Disorders:psychotic behavior including aggressive thoughts.

    Renal and Urinary Disorders:tubulointerstitial nephritis.

    Skin and Subcutaneous Tissue Disorders:generalized rash, Stevens-Johnson Syndrome, hypersensitivity skin reactions, erythema multiforme, drug reaction with eosinophilia and systemic symptoms, toxic epidermal necrolysis.

  • 7 DRUG INTERACTIONS

    7.1 Xanthine Oxidase Substrate Drugs

    Febuxostat tablet is an XO inhibitor. Based on a drug interaction study in healthy patients, febuxostat altered the metabolism of theophylline (a substrate of XO) in humans [see Clinical Pharmacology (12.3)]. Therefore, use with caution when coadministering febuxostat tablets with theophylline.

    A drug interaction study of febuxostat tablets and azathioprine, also metabolized by XO, showed an increase in exposure of 6-mercaptopurine which may lead to toxicity [see Clinical Pharmacology (12.3)] . Drug interaction studies of febuxostat tablets with other drugs that are metabolized by XO (e.g., mercaptopurine) have not been conducted. Febuxostat tablets are contraindicated in patients being treated with azathioprine or mercaptopurine  [see Contraindications (4)].

    7.2 Cytotoxic Chemotherapy Drugs

    Drug interaction studies of febuxostat tablets with cytotoxic chemotherapy have not been conducted. No data are available regarding the safety of febuxostat tablets during cytotoxic chemotherapy.

    7.3 In VivoDrug Interaction Studies

    Based on drug interaction studies in healthy patients, febuxostat tablets do not have clinically significant interactions with colchicine, naproxen, indomethacin, hydrochlorothiazide, warfarin or desipramine [see Clinical Pharmacology (12.3)]. Therefore, febuxostat tablets may be used concomitantly with these medications.

  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Risk Summary

    Limited available data with febuxostat tablets use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes. No adverse developmental effects were observed in embryo-fetal development studies with oral administration of febuxostat to pregnant rats and rabbits during organogenesis at doses that produced maternal exposures up to 40 and 51 times, respectively, the exposure at the maximum recommended human dose (MRHD). No adverse developmental effects were observed in a pre- and postnatal development study with administration of febuxostat to pregnant rats from organogenesis through lactation at an exposure approximately 11 times the MRHD (see Data) .

    The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.

    Data

    Animal Data

    In an embryo-fetal development study in pregnant rats dosed during the period of organogenesis from gestation Days 7 – 17, febuxostat was not teratogenic and did not affect fetal development or survival at exposures up to approximately 40 times the MRHD (on an AUC basis at maternal oral doses up to 48 mg/kg/day). In an embryo-fetal development study in pregnant rabbits dosed during the period of organogenesis from gestation Days 6 – 18, febuxostat was not teratogenic and did not affect fetal development at exposures up to approximately 51 times the MRHD (on an AUC basis at maternal oral doses up to 48 mg/kg/day).

    In a pre- and postnatal development study in pregnant female rats dosed orally from gestation Day 7 through lactation Day 20, febuxostat had no effects on delivery or growth and development of offspring at a dose approximately 11 times the MRHD (on an AUC basis at a maternal oral dose of 12 mg/kg/day). However, increased neonatal mortality and a reduction in neonatal body weight gain were observed in the presence of maternal toxicity at a dose approximately 40 times the MRHD (on an AUC basis at a maternal oral dose of 48 mg/kg/day).

    Febuxostat crossed the placental barrier following oral administration to pregnant rats and was detected in fetal tissues.

    8.2 Lactation

    Risk Summary

    There are no data on the presence of febuxostat in human milk, the effects on the breastfed infant, or the effects on milk production. Febuxostat is present in rat milk. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for febuxostat tablets and any potential adverse effects on the breastfed child from febuxostat tablets or from the underlying maternal condition.

    Data

    Animal Data

    Orally administered febuxostat was detected in the milk of lactating rats at up to approximately 7 times the plasma concentration.

    8.4 Pediatric Use

    Safety and effectiveness of febuxostat tablets in pediatric patients have not been established.

    8.5 Geriatric Use

    No dose adjustment is necessary in elderly patients. Of the total number of patients in Studies 1, 2, and 3 (clinical studies of febuxostat tablets in the treatment of gout) [see Clinical Studies (14.1)] , 16% were 65 and over, while 4% were 75 and over. Comparing patients in different age groups, no clinically significant differences in safety or effectiveness were observed but greater sensitivity of some older individuals cannot be ruled out. The C maxand AUC 24of febuxostat following multiple oral doses of febuxostat tablets in geriatric patients (≥ 65 years) were similar to those in younger patients (18 to 40 years) [see Clinical Pharmacology (12.3)].

    8.6 Renal Impairment

    No dose adjustment is necessary in patients with mild to moderate renal impairment (Cl cr30 to 89 mL/min). For patients with severe renal impairment (Cl cr15 to 29 mL/min), the recommended dosage of febuxostat tablets is limited to 40 mg once daily [see Dosage and Administration (2.2)and Clinical Pharmacology (12.3)].

    8.7 Hepatic Impairment

    No dose adjustment is necessary in patients with mild or moderate hepatic impairment (Child-Pugh Class A or B). No studies have been conducted in patients with severe hepatic impairment (Child-Pugh Class C); therefore, caution should be exercised in these patients [see Clinical Pharmacology (12.3)].

    8.8 Secondary Hyperuricemia

    No studies have been conducted in patients with secondary hyperuricemia (including organ transplant recipients); febuxostat tablets are not recommended for use in patients whom the rate of urate formation is greatly increased (e.g., malignant disease and its treatment, Lesch-Nyhan syndrome). The concentration of xanthine in urine could, in rare cases, rise sufficiently to allow deposition in the urinary tract.

  • 10 OVERDOSAGE

    Febuxostat tablets were studied in healthy patients in doses up to 300 mg daily for seven days without evidence of dose-limiting toxicities. No overdose of febuxostat tablets were reported in clinical studies. Patients should be managed by symptomatic and supportive care should there be an overdose.

  • 11 DESCRIPTION

    Febuxostat tablet is a xanthine oxidase inhibitor. The active ingredient in febuxostat tablets is 2-[3-cyano-4-(2-methylpropoxy) phenyl]-4-methylthiazole-5-carboxylic acid, with a molecular weight of 316.38. The empirical formula is C 16H 16N 2O 3S.

    The chemical structure is:

    chemical structure

    Febuxostat is a non-hygroscopic, white crystalline powder that is freely soluble in dimethylformamide; soluble in dimethylsulfoxide; sparingly soluble in ethanol; slightly soluble in methanol and acetonitrile; and practically insoluble in water. The melting range is 205°C to 208°C.

    Febuxostat tablets for oral use contain the active ingredient, febuxostat, and are available in two dosage strengths, 40 mg and 80 mg. Inactive ingredients include croscarmellose sodium, hydroxypropyl cellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, silicon dioxide. Febuxostat tablets are coated with Opadry II, white, the ingredients of Opadry II are polyethylene glycol, polyvinyl alcohol, talc and titanium dioxide.

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    Febuxostat tablets, a xanthine oxidase inhibitor, achieves its therapeutic effect by decreasing serum uric acid. Febuxostat tablets are not expected to inhibit other enzymes involved in purine and pyrimidine synthesis and metabolism at therapeutic concentrations.

    12.2 Pharmacodynamics

    Effect on Uric Acid and Xanthine Concentrations

    In healthy patients, febuxostat tablets resulted in a dose dependent decrease in 24-hour mean serum uric acid concentrations and an increase in 24-hour mean serum xanthine concentrations. In addition, there was a decrease in the total daily urinary uric acid excretion. Also, there was an increase in total daily urinary xanthine excretion. Percent reduction in 24-hour mean serum uric acid concentrations was between 40% and 55% at the exposure levels of 40 mg and 80 mg daily doses.

    Effect on Cardiac Repolarization

    The effect of febuxostat tablets on cardiac repolarization as assessed by the QTc interval was evaluated in normal healthy patients and in patients with gout. Febuxostat tablets in doses up to 300 mg daily (3.75 times the maximum recommended daily dosage), at steady-state, did not demonstrate an effect on the QTc interval.

    12.3 Pharmacokinetics

    In healthy patients, maximum plasma concentrations (C max) and AUC of febuxostat increased in a dose proportional manner following single and multiple doses of 10 mg (0.25 times the lowest recommended dosage) to 120 mg (1.5 times the maximum recommended dosage). There is no accumulation when therapeutic doses are administered every 24 hours. Febuxostat has an apparent mean terminal elimination half-life (t 1/2) of approximately 5 to 8 hours. Febuxostat pharmacokinetic parameters for patients with hyperuricemia and gout estimated by population pharmacokinetic analyses were similar to those estimated in healthy patients.

    Absorption

    The absorption of radiolabeled febuxostat following oral dose administration was estimated to be at least 49% (based on total radioactivity recovered in urine). Maximum plasma concentrations of febuxostat occurred between 1 and 1.5 hours postdose. After multiple oral 40 mg and 80 mg once daily doses, C maxis approximately 1.6 ± 0.6 mcg/mL (N=30), and 2.6 ± 1.7 mcg/mL (N=227), respectively. Absolute bioavailability of the febuxostat tablet has not been studied.

    Following multiple 80 mg once daily doses with a high fat meal, there was a 49% decrease in C maxand an 18% decrease in AUC, respectively. However, no clinically significant change in the percent decrease in serum uric acid concentration was observed (58% fed vs 51% fasting). Thus, febuxostat tablets may be taken without regard to food.

    Concomitant ingestion of an antacid containing magnesium hydroxide and aluminum hydroxide with an 80 mg single dose of febuxostat tablets has been shown to delay absorption of febuxostat (approximately one hour) and to cause a 31% decrease in C maxand a 15% decrease in AUC ∞. As AUC rather than C maxwas related to drug effect, change observed in AUC was not considered clinically significant. Therefore, febuxostat tablets may be taken without regard to antacid use.

    Distribution

    The mean apparent steady state volume of distribution (V ss/F) of febuxostat was approximately 50 L (CV ~40%). The plasma protein binding of febuxostat is approximately 99.2% (primarily to albumin), and is constant over the concentration range achieved with 40 mg and 80 mg doses.

    Metabolism

    Febuxostat is extensively metabolized by both conjugation via uridine diphosphate glucuronosyltransferase (UGT) enzymes including UGT1A1, UGT1A3, UGT1A9, and UGT2B7 and oxidation via cytochrome P450 (CYP) enzymes including CYP1A2, 2C8 and 2C9 and non-P450 enzymes. The relative contribution of each enzyme isoform in the metabolism of febuxostat is not clear. The oxidation of the isobutyl side chain leads to the formation of four pharmacologically active hydroxy metabolites, all of which occur in plasma of humans at a much lower extent than febuxostat.

    In urine and feces, acyl glucuronide metabolites of febuxostat (~35% of the dose), and oxidative metabolites, 67M-1 (~10% of the dose), 67M-2 (~11% of the dose), and 67M-4, a secondary metabolite from 67M-1 (~14% of the dose), appeared to be the major metabolites of febuxostat in vivo.

    Elimination

    Febuxostat is eliminated by both hepatic and renal pathways. Following an 80 mg oral dose of 14C-labeled febuxostat, approximately 49% of the dose was recovered in the urine as unchanged febuxostat (3%), the acyl glucuronide of the drug (30%), its known oxidative metabolites and their conjugates (13%), and other unknown metabolites (3%). In addition to the urinary excretion, approximately 45% of the dose was recovered in the feces as the unchanged febuxostat (12%), the acyl glucuronide of the drug (1%), its known oxidative metabolites and their conjugates (25%), and other unknown metabolites (7%).

    The apparent mean terminal elimination half-life (t 1/2) of febuxostat was approximately 5 to 8 hours.

    Specific Populations

    Geriatric Patients

    The C maxand AUC of febuxostat and its metabolites following multiple oral doses of febuxostat tablets in geriatric patients (≥ 65 years) were similar to those in younger patients (18 to 40 years). In addition, the percent decrease in serum uric acid concentration was similar between elderly and younger patients. No dose adjustment is necessary in geriatric patients [see Use in Specific Populations (8.5)].

    Patients with Renal Impairment

    In a dedicated phase I pharmacokinetics study, following multiple 80 mg doses of febuxostat tablets in healthy patients with mild (Cl cr50 to 80 mL/min), moderate (Cl cr30 to 49 mL/min) or severe renal impairment (Cl cr10 to 29 mL/min), the C maxof febuxostat did not change relative to patients with normal renal function (Cl crgreater than 80 mL/min). AUC and half-life of febuxostat increased in patients with renal impairment in comparison to patients with normal renal function, but values were similar among three renal impairment groups. Mean febuxostat AUC values were up to 1.8 times higher in patients with renal impairment compared to those with normal renal function. Mean C maxand AUC values for three active metabolites increased up to two and four-fold, respectively. However, the percent decrease in serum uric acid concentration for patients with renal impairment was comparable to those with normal renal function (58% in normal renal function group and 55% in the severe renal function group).

    Based on population pharmacokinetic analysis, following multiple 40 mg or 80 mg doses of febuxostat tablets, the mean oral clearance (CL/F) values of febuxostat in patients with gout and mild (n=334), moderate (n=232) or severe (n=34) renal impairment were decreased by 14%, 34%, and 48%, respectively, compared to patients with normal (n=89) renal function. The corresponding median AUC values of febuxostat at steady-state in patients with renal impairment were increased by 18%, 49%, and 96% after 40 mg dose, and 7%, 45% and 98% after 80 mg dose, respectively, compared to patients with normal renal function.

    Febuxostat tablets have not been studied in end stage renal impairment patients who are on dialysis.

    Patients with Hepatic Impairment

    Following multiple 80 mg doses of febuxostat tablets in patients with mild (Child-Pugh Class A) or moderate (Child-Pugh Class B) hepatic impairment, an average of 20% to 30% increase was observed for both C maxand AUC 24(total and unbound) in hepatic impairment groups compared to patients with normal hepatic function. In addition, the percent decrease in serum uric acid concentration was comparable between different hepatic groups (62% in healthy group, 49% in mild hepatic impairment group, and 48% in moderate hepatic impairment group). No dose adjustment is necessary in patients with mild or moderate hepatic impairment. No studies have been conducted in patients with severe hepatic impairment (Child-Pugh Class C); caution should be exercised in those patients [see Use in Specific Populations (8.7)].

    Male and Female Patients

    Following multiple oral doses of febuxostat tablets, the C maxand AUC 24of febuxostat were 30% and 14% higher in females than in males, respectively. However, weight-corrected C maxand AUC were similar between the genders. In addition, the percent decrease in serum uric acid concentrations was similar between genders. No dose adjustment is necessary based on gender.

    Racial Groups

    No specific pharmacokinetic study was conducted to investigate the effects of race.

    Drug Interaction Studies

    Effect of Febuxostat Tablets on Other Drugs

    Xanthine Oxidase Substrate Drugs-Azathioprine, Mercaptopurine, and Theophylline

    Febuxostat is an XO inhibitor. A drug-drug interaction study evaluating the effect of febuxostat tablets upon the pharmacokinetics of theophylline (an XO substrate) in healthy patients showed that coadministration of febuxostat with theophylline resulted in an approximately 400-fold increase in the amount of 1-methylxanthine, one of the major metabolites of theophylline, excreted in the urine. Since the long-term safety of exposure to 1-methylxanthine in humans is unknown, use with caution when coadministering febuxostat with theophylline.

    A drug interaction study of febuxostat tablets and azathioprine has been conducted [see Drug Interactions (7)] . Inhibition of XO by febuxostat tablets caused increased plasma concentrations of 6-mercaptopurine, a metabolite of azathioprine, which may lead to toxicity. Drug interaction studies of febuxostat tablets with other drugs that are metabolized by XO (e.g., mercaptopurine) have not been conducted. Febuxostat tablets are contraindicated in patients being treated with azathioprine or mercaptopurine [see Contraindications (4)and Drug Interactions (7)].

    Azathioprine and mercaptopurine undergo metabolism via three major metabolic pathways, one of which is mediated by XO. Concomitant administration of allopurinol [a xanthine oxidase inhibitor] with azathioprine or mercaptopurine has been reported to substantially increase plasma concentrations of these drugs. Because febuxostat tablet is a xanthine oxidase inhibitor, it could inhibit the XO-mediated metabolism of mercaptopurine leading to increased plasma concentrations of mercaptopurine that could result in severe toxicity.

    P450 Substrate Drugs

    In vitrostudies have shown that febuxostat does not inhibit P450 enzymes CYP1A2, 2C9, 2C19, 2D6, or 3A4 and it also does not induce CYP1A2, 2B6, 2C9, 2C19, or 3A4 at clinically relevant concentrations. As such, pharmacokinetic interactions between febuxostat tablets and drugs metabolized by these CYP enzymes are unlikely.

    Effect of Other Drugs on Febuxostat Tablets

    Febuxostat is metabolized by conjugation and oxidation via multiple metabolizing enzymes. The relative contribution of each enzyme isoform is not clear. Drug interactions between febuxostat tablets and a drug that inhibits or induces one particular enzyme isoform is in general not expected.

    In Vivo Drug Interaction Studies

    Theophylline

    No dose adjustment is necessary for theophylline when coadministered with febuxostat tablets. Administration of febuxostat tablets (80 mg once daily) with theophylline resulted in an increase of 6% in C maxand 6.5% in AUC of theophylline. These changes were not considered statistically significant. However, the study also showed an approximately 400-fold increase in the amount of 1-methylxanthine (one of the major theophylline metabolites) excreted in urine as a result of XO inhibition by febuxostat tablets. The safety of long-term exposure to 1-methylxanthine has not been evaluated. This should be taken into consideration when deciding to coadminister febuxostat tablets and theophylline.

    Colchicine

    No dose adjustment is necessary for either febuxostat tablets or colchicine when the two drugs are coadministered. Administration of febuxostat tablets (40 mg once daily) with colchicine (0.6 mg twice daily) resulted in an increase of 12% in C maxand 7% in AUC 24of febuxostat. In addition, administration of colchicine (0.6 mg twice daily) with febuxostat tablets (120 mg daily) resulted in a less than 11% change in C maxor AUC of colchicine for both AM and PM doses. These changes were not considered clinically significant.

    Naproxen

    No dose adjustment is necessary for febuxostat tablets or naproxen when the two drugs are coadministered. Administration of febuxostat tablets (80 mg once daily) with naproxen (500 mg twice daily) resulted in a 28% increase in C maxand a 40% increase in AUC of febuxostat. The increases were not considered clinically significant. In addition, there were no significant changes in the C maxor AUC of naproxen (less than 2%).

    Indomethacin

    No dose adjustment is necessary for either febuxostat tablets or indomethacin when these two drugs are coadministered. Administration of febuxostat tablets (80 mg once daily) with indomethacin (50 mg twice daily) did not result in any significant changes in C maxor AUC of febuxostat or indomethacin (less than 7%).

    Hydrochlorothiazide

    No dose adjustment is necessary for febuxostat tablets when coadministered with hydrochlorothiazide. Administration of febuxostat tablets (80 mg) with hydrochlorothiazide (50 mg) did not result in any clinically significant changes in C maxor AUC of febuxostat (less than 4%), and serum uric acid concentrations were not substantially affected.

    Warfarin

    No dose adjustment is necessary for warfarin when coadministered with febuxostat tablets. Administration of febuxostat tablets (80 mg once daily) with warfarin had no effect on the pharmacokinetics of warfarin in healthy patients. INR and Factor VII activity were also not affected by the coadministration of febuxostat tablets.

    Desipramine

    Coadministration of drugs that are CYP2D6 substrates (such as desipramine) with febuxostat tablets are not expected to require dose adjustment. Febuxostat was shown to be a weak inhibitor of CYP2D6 in vitroand in vivo. Administration of febuxostat tablets (120 mg once daily) with desipramine (25 mg) resulted in an increase in C max(16%) and AUC (22%) of desipramine, which was associated with a 17% decrease in the 2-hydroxydesipramine to desipramine metabolic ratio (based on AUC).

  • 13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

    Two-year carcinogenicity studies were conducted in F344 rats and B6C3F1 mice. Increased transitional cell papilloma and carcinoma of the urinary bladder was observed at 24 mg/kg (25 times the MRHD on an AUC basis and 18.75 mg/kg (12.5 times the MRHD on an AUC basis) in male rats and female mice, respectively. The urinary bladder neoplasms were secondary to calculus formation in the kidney and urinary bladder.

    Febuxostat showed a positive clastogenic response in a chromosomal aberration assay in a Chinese hamster lung fibroblast cell line with and without metabolic activation in vitro. Febuxostat was negative in the following genotoxicity assays: the in vitroAmes assay, in vitrochromosomal aberration assay in human peripheral lymphocytes, the L5178Y mouse lymphoma cell line assay, the in vivomouse micronucleus assay, and the rat unscheduled DNA synthesis assay.

    Fertility and reproductive performance were unaffected in male or female rats that received febuxostat at oral doses up to 48 mg/kg/day (approximately 31 and 40 times the MRHD on an AUC basis in males and females respectively).

    13.2 Animal Toxicology

    A 12 month toxicity study in beagle dogs showed deposition of xanthine crystals and calculi in kidneys at 15 mg/kg (approximately 4 times the MRHD on an AUC basis). A similar effect of calculus formation was noted in rats in a six month study due to deposition of xanthine crystals at 48 mg/kg (approximately 31 and 40 times the MRHD on an AUC basis in males and females respectively).

  • 14 CLINICAL STUDIES

    A serum uric acid level of less than 6 mg/dL is the goal of antihyperuricemic therapy and has been established as appropriate for the treatment of gout.

    14.1 Management of Hyperuricemia in Gout

    The efficacy of febuxostat tablets was demonstrated in three randomized, double-blind, controlled trials in patients with hyperuricemia and gout. Hyperuricemia was defined as a baseline serum uric acid level ≥ 8 mg/dL.

    Study 1 ( NCT00430248) randomized patients to: febuxostat tablets 40 mg daily, febuxostat tablets 80 mg daily, or allopurinol (300 mg daily for patients with estimated creatinine clearance (Cl cr) ≥ 60 mL/min or 200 mg daily for patients with estimated Cl cr≥ 30 mL/min and ≤ 59 mL/min). The duration of Study 1 was six months.

    Study 2 ( NCT00174915) randomized patients to: placebo, febuxostat tablets 80 mg daily, febuxostat tablets 120 mg daily, febuxostat tablets 240 mg daily or allopurinol (300 mg daily for patients with a baseline serum creatinine ≤ 1.5 mg/dL or 100 mg daily for patients with a baseline serum creatinine greater than 1.5 mg/dL and ≤ 2 mg/dL). The duration of Study 2 was six months.

    Study 3 ( NCT00102440), a year study, randomized patients to: febuxostat tablets 80 mg daily, febuxostat tablets 120 mg daily, or allopurinol 300 mg daily. Patients who completed Study 2 and Study 3 were eligible to enroll in a Phase 3 long-term extension study in which patients received treatment with febuxostat tablets for over three years.

    In all three studies, patients received naproxen 250 mg twice daily or colchicine 0.6 mg once or twice daily for gout flare prophylaxis. In Study 1 the duration of prophylaxis was six months; in Study 2 and Study 3 the duration of prophylaxis was eight weeks.

    The efficacy of febuxostat tablets was also evaluated in a 4-week dose ranging study which randomized patients to: placebo, febuxostat tablets 40 mg daily, febuxostat tablets 80 mg daily, or febuxostat tablets 120 mg daily. Patients who completed this study were eligible to enroll in a long-term extension study in which patients received treatment with febuxostat tablets for up to five years.

    Patients in these studies were representative of the patient population for which febuxostat tablets use is intended. Table 2 summarizes the demographics and baseline characteristics for the patients enrolled in the studies.

    Table 2: Patient Demographics and Baseline Characteristics in Study 1, Study 2, and Study 3
    Male95%
    Race: Caucasian80%
     African American10%
    Ethnicity: Hispanic or Latino7%
    Alcohol User67%
    Mild to Moderate Renal Insufficiency
    (percent with estimated Cl crless than 90 mL/min)     		59%
    History of Hypertension49%
    History of Hyperlipidemia38%
    BMI ≥ 30 kg/m 263%
    Mean BMI33 kg/m 2
    Baseline sUA ≥ 10 mg/dL36%
    Mean baseline sUA9.7 mg/dL
    Experienced a gout flare in previous year85%

    Serum Uric Acid Level less than 6 mg/dL at Final Visit

    Febuxostat tablets 80 mg were superior to allopurinol in lowering serum uric acid to less than 6 mg/dL at the final visit. Febuxostat tablets 40 mg daily, although not superior to allopurinol, was effective in lowering serum uric acid to less than 6 mg/dL at the final visit (Table 3).

    Table 3: Proportion of Patients with Serum Uric Acid Levels less than 6 mg/dL at Final Visit
    Difference in Proportion
    (95% CI)
    Study *Febuxostat tablets
    40 mg daily     		Febuxostat tablets
    80 mg daily     		allopurinolPlaceboFebuxostat tablets
    40 mg
    vs
    allopurinol     		Febuxostat tablets
    80 mg
    vs
    allopurinol
  • * Randomization was balanced between treatment groups, except in Study 2 in which twice as many patients were randomized to each of the active treatment groups compared to placebo.
    		•
    Study 1
    (6 months)
    (N=2268)     		45%67%42%3%
    (-2%, 8%)     		25%
    (20%, 30%)
    Study 2
    (6 months)
    (N=643)     		72%39%1%33%
    (26%, 42%)
    Study 3
    (12 months)
    (N=491)     		74%36%38%
    (30%, 46%)

    In 76% of febuxostat tablets 80 mg patients, reduction in serum uric acid levels to less than 6 mg/dL was noted by the Week 2 visit. Average serum uric acid levels were maintained at 6 mg/dL or below throughout treatment in 83% of these patients.

    In all treatment groups, fewer patients with higher baseline serum urate levels (≥ 10 mg/dL) and/or tophi achieved the goal of lowering serum uric acid to less than 6 mg/dL at the final visit; however, a higher proportion achieved a serum uric acid less than 6 mg/dL with febuxostat tablets 80 mg than with febuxostat tablets 40 mg or allopurinol.

    Study 1 evaluated efficacy in patients with mild to moderate renal impairment (i.e., baseline estimated Cl crless than 90 mL/min). The results in this subgroup of patients are shown in Table 4.

    Table 4: Proportion of Patients with Serum Uric Acid Levels less than 6 mg/dL in Patients with Mild or Moderate Renal Impairment at Final Visit
    Difference in Proportion
    (95% CI)
    Febuxostat tablets
    40 mg daily
    (N=479)     		Febuxostat tablets
    80 mg daily
    (N=503)     		allopurinol *
    300 mg daily
    (N=501)     		Febuxostat tablets
    40 mg
    vs
    allopurinol     		Febuxostat tablets
    80 mg
    vs
    allopurinol
  • * Allopurinol patients (n=145) with estimated Cl cr ≥ 30 mL/min and Cl cr ≤59 mL/min were dosed at 200 mg daily.
    		•
    50%72%42%7%
    (1%, 14%)     		29%
    (23%, 35%)

    14.2 Cardiovascular Safety Study

    A randomized, double-blind, allopurinol-controlled CV outcomes study (CARES) was conducted to evaluate the CV risk of febuxostat tablets ( NCT01101035). The study compared the risk of MACE between patients treated with febuxostat tablets (N=3098) and allopurinol-treated patients (N=3092). The primary endpoint was the time to first occurrence of a MACE defined as the composite of CV death, nonfatal MI, nonfatal stroke, or unstable angina with urgent coronary revascularization. The study was designed to exclude a prespecified risk margin of 1.3 for the hazard ratio of MACE. An independent committee conducted a blinded evaluation of serious CV adverse events according to predefined criteria (adjudication) for determination of MACE. The study was event driven and patients were followed until a sufficient number of primary outcome events accrued. The median on-study follow-up time was 2.6 years.

    Patients randomized to febuxostat tablets initially received 40 mg once daily which was increased to 80 mg once daily, if their sUA was ≥ 6mg/dL at Week 2. For patients randomized to allopurinol, those who had normal renal function or mild renal impairment (estimated creatinine clearance (eCl cr) ≥ 60 to ˂90 mL/minute) initially received 300 mg once daily with 100 mg/day dose increments monthly until either sUA ˂6mg/dL or an allopurinol dosage of 600 mg once daily was achieved; those who had moderate renal impairment (eCl cr≥ 30 to ˂60 mL/minute) initially received 200 mg once daily with 100 mg/day dose increments monthly until either a sUA ˂6 mg/dL or an allopurinol dosage of 400 mg once daily was achieved.

    The mean age of the population was 65 years (range: 44 to 93 years). Most patients were male (84%) and Caucasian (69%). Patients had a diagnosis of gout for approximately 12 years, a mean baseline sUA of 8.7 mg/dL, and 90% had experienced at least one gout flare in the past year. CV history included MI (39%), hospitalization for unstable angina (28%), cardiac revascularization (37%), and stroke (14%). The most prevalent comorbid conditions were hypertension (92%), hyperlipidemia (87%), diabetes mellitus (55%), diabetes mellitus with micro- or macrovascular disease (39%), and renal impairment [92% with an eCl cr30 to 89 mL/minute]. The use of CV disease medication was balanced across treatment groups. Baseline CV disease medications included: ACE inhibitors or ARBs (70%), lipid modifying agents (74%), aspirin (62%), beta-blockers (59%), calcium channel blockers (26%), and nonaspirin antiplatelet medications (31%).

    Table 5 shows the study results for the primary MACE composite endpoint and its individual components. For the composite primary endpoint, the febuxostat tablets group was non-inferior compared with the allopurinol group. The rates of nonfatal MI, stroke, and unstable angina with urgent coronary revascularization were similar. There was a higher rate of CV deaths in patients treated with febuxostat tablets (134 CV deaths; 1.5 per 100 PY) than in allopurinol-treated patients (100 CV deaths; 1.1 per 100 PY). Sudden cardiac death was the most common cause of adjudicated CV deaths in the febuxostat tablets group (83 of 3,098; 2.7%) as compared to the allopurinol group (56 of 3,092; 1.8%). The biological plausibility of CV death associated with febuxostat tablets is unclear.

    All-cause mortality was higher in the febuxostat tablets group (243 deaths [7.8%]; 2.6 per 100 PY) than the allopurinol group (199 deaths [6.4%]; 2.2 per 100 PY) [Hazard Ratio: 1.22, 95% CI: 1.01, 1.47], due to a higher rate of CV deaths.

    Table 5: Patients with MACE in CARES (Cardiovascular Outcomes Study in Patients with Gout)
    Febuxostat Tablets
    N=3098     		Allopurinol
    N=3092     		Hazard Ratio
    Number of Patients with Event (%)Rate per 100 PY *Number of Patients with Event (%)Rate per 100 PY *95% CI
  • * Patient Years (PY)
    		•
    Composite of primary endpoint MACE335 (10.8)3.8321 (10.4)3.71.03 (0.89, 1.21)
      Cardiovascular Death134 (4.3)1.5100 (3.2)1.11.34 (1.03, 1.73)
      Nonfatal MI111 (3.6)1.2118 (3.8)1.30.93 (0.72, 1.21)
      Nonfatal stroke71 (2.3)0.870 (2.3)0.81.01 (0.73, 1.41)
      Unstable angina with urgent coronary revascularization49 (1.6)0.556 (1.8)0.60.86 (0.59, 1.26)

  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    Febuxostat tablets 40 mg are white or almost white round film-coated tablets, debossed with “C33” on one side and blank on the other side and supplied as:

    NDC NumberSize
    0527-2244-32Bottle of 30 Tablets

    Febuxostat tablets 80 mg are white or almost white capsule-shaped film-coated tablets, debossed with “C32” on one side and blank on the other side and supplied as:

    NDC NumberSize
    0527-2248-32Bottle of 30 Tablets

    Protect from light. Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) [See USP Controlled Room Temperature].

  • 17 PATIENT COUNSELING INFORMATION

    Advise the patient to read the FDA-approved patient labeling (Medication Guide).

    CV Death

    Inform patients that gout patients with established CV disease treated with febuxostat tablets had a higher rate of CV death compared to those treated with allopurinol in a CV outcomes study. Inform all patients of the higher rate of CV death with febuxostat tablets compared to allopurinol. Alert all patients (those with and without CV disease) for the development of signs and symptoms of CV events and to seek medical care promptly should they occur  [see Warnings and Precautions (5.1)] .

    Gout Flares

    Inform patients that after initiation of febuxostat tablets an increase in gout flares can occur and that is not reason to stop taking the medication. Instruct patients that it is recommended to initiate and continue gout prophylaxis therapy for six months while taking febuxostat tablets  [see Warnings and Precautions (5.2)] .

    Hepatic Effects

    Inform patients that hepatic effects, including fatal ones, have occurred in patients treated with febuxostat tablets. Instruct them to inform their healthcare provider if they experience liver injury symptoms [see Warnings and Precautions (5.3)] .

    Serious Skin Reactions

    Inform patients that serious skin and hypersensitivity reactions have occurred in patients treated with febuxostat tablets. Instruct patients to discontinue febuxostat tablets if they develop symptoms of these reactions [see Warnings and Precautions (5.4)] .


    Trademarks are the property of their respective owners.


    Distributed by:

    Lannett Company, Inc.

    Philadelphia, PA 19136


    Manufactured by:

    logo0001-01Sunshine Lake Pharma Co., Ltd.

    No. 1, Northern Industry Road,

    Northern Industry Park of Song Shan Lake,

    DongGuan, GuangDong, 523808,China

    Revised: 01/2024                                                                                                                                                                        L7265A

  • PATIENT PACKAGE INSERT

    This Medication Guide has been approved by the U.S. Food and Drug Administration                            Revised: January 2024
    MEDICATION GUIDE

    FEBUXOSTAT (fe bux' oh stat)

    tablets, for oral use
    Read the Medication Guide that comes with febuxostat tablets before you start taking it and each time you get a refill. There may be new information. The Medication Guide does not take the place of talking with your doctor about your medical condition or your treatment.
    What is the most important information that I should know about febuxostat tablets?

    Febuxostat tablets may cause serious side effects, including:

    Heart-related deaths.

    Call your doctor or get emergency medical help right away if you have any of the following symptoms, especially if they are new, worse, or worry you:
    • chest pain
    • shortness of breath or trouble breathing
    • dizziness, fainting or feeling lightheaded
    • rapid or irregular heartbeat
    • numbness or weakness on one side of your body
    • slurring of speech
    • sudden blurry vision or sudden severe headache
    What are febuxostat tablets?

    Febuxostat tablet is a prescription medicine called a xanthine oxidase (XO) inhibitor used to lower blood uric acid levels in adult patients with gout when allopurinol has not worked well enough or when allopurinol is not right for you.

    Febuxostat tablets are not for use in people who do not have symptoms of high blood uric acid levels.

    It is not known if febuxostat tablets are safe and effective in children.
    Who should not take febuxostat tablets?

    Do not take febuxostat tablets if you:
    • take azathioprine (Azasan, Imuran)
    • take mercaptopurine (Purinethol, Purixan)
    What should I tell my doctor before taking febuxostat tablets?

    Before taking febuxostat tablets tell your doctor about all of your medical conditions, including if you:
    • have taken allopurinol and what happened to you while you were taking it.
    • have a history of heart disease or stroke.
    • have liver or kidney problems.
    • are pregnant or plan to become pregnant. It is not known if febuxostat tablets will harm your unborn baby. Talk with your doctor if you are pregnant or plan to become pregnant.
    • are breastfeeding or plan to breastfeed. It is not known if febuxostat passes into your breast milk. You and your doctor should decide if you should take febuxostat tablets while breastfeeding.
    Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Febuxostat tablets may affect the way other medicines work, and other medicines may affect how febuxostat tablets work.

    Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.
    How should I take febuxostat tablets?
    • Take febuxostat tablets exactly as your doctor tells you to take it.
    • Febuxostat tablets can be taken with or without food.
    • Febuxostat tablets can be taken with antacids.
    • Your gout may get worse (flare) when you start taking febuxostat tablets. Do not stop taking febuxostat tablets because you have a flare.
    Your doctor may do certain tests while you take febuxostat tablets.
    What are the possible side effects of febuxostat tablets?

    Febuxostat tablets may cause serious side effects, including:
    • Heart problems.See " What is the most important information I should know about febuxostat tablets?" .
    • Gout Flares.Gout flares can happen when you start taking febuxostat tablets. Your doctor may give you other medicines to help prevent your gout flares.
    • Liver problems.Liver problems can happen in people who take febuxostat tablets. Your doctor may do blood tests to check how well your liver is working before and during your treatment with febuxostat tablets. Tell your doctor if you get any of the following signs or symptoms of liver problems:
    • fatigue
    • loss of appetite for several days or longer
    • pain, aching, or tenderness on the right side of your stomach-area
    • dark or "tea-colored" urine
    • your skin or the white part of your eyes turns yellow (jaundice)
    • Severe skin and allergic reactions.Serious skin and allergic reactions that may affect different parts of the body such as your liver, kidneys, heart or lungs, can happen in people who take febuxostat tablets. Call your doctor right away or get emergency medical help if you have any of the following symptoms:
    • rash
    • red and painful skin
    • severe skin blisters
    • peeling skin
    • sores around the lips, eyes or mouth
    • swollen face, lips, mouth, tongue or throat
    • flu-like symptoms
    The most common side effects of febuxostat tablets include:
    • abnormal liver function tests
    • nausea
    • joint pain
    • rash
    These are not all of the possible side effects of febuxostat tablets.

    Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
    How should I store febuxostat tablets?
    • Store febuxostat tablets at room temperature.
    • Keep febuxostat tablets out of the light.
    Keep febuxostat tablets and all medicines out of the reach of children.
    General information about the safe and effective use of febuxostat tablets.

    Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use febuxostat tablets for a condition for which it was not prescribed. Do not give febuxostat tablets to other people, even if they have the same symptoms that you have. It may harm them.

    You can ask your doctor or pharmacist for information about febuxostat tablets that is written for health professionals.
    What are the ingredients in febuxostat tablets?

    Active ingredient:     febuxostat

    Inactive ingredients:croscarmellose sodium, hydroxypropyl cellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, silicon dioxide, and Opadry II, white, the ingredients of Opadry II are polyethylene glycol, polyvinyl alcohol, talc and titanium dioxide.


    Trademarks are the property of their respective owners.


    Distributed by:

    Lannett Company, Inc.

    Philadelphia, PA 19136


    Manufactured by:

    logo0001-02Sunshine Lake Pharma Co., Ltd.
    No. 1, Northern Industry Road,
    Northern Industry Park of Song Shan Lake, 

    DongGuan, GuangDong, 523808,China


    For more information, contact Lannett Company, Inc. at 1-844-834-0530.

                                                                                                                                                                                                           L7266A
                                                                                                                                                                                                            11792

  • PRINCIPAL DISPLAY PANEL - 40 mg Tablet Bottle Label

    NDC: 0527-2244-32

    30 Tablets

    Febuxostat
    tablets

    40 mg

    Rx only

    40 mg

  • PRINCIPAL DISPLAY PANEL - 80 mg Tablet Bottle Label

    NDC: 0527-2248-32

    30 Tablets

    Febuxostat
    tablets

    80 mg

    Rx only

    ​ 80 mg

  • INGREDIENTS AND APPEARANCE
    FEBUXOSTAT 
    febuxostat tablet
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC: 0527-2248
    Route of AdministrationORAL
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    FEBUXOSTAT (UNII: 101V0R1N2E) (FEBUXOSTAT - UNII:101V0R1N2E) FEBUXOSTAT80 mg
    Inactive Ingredients
    Ingredient NameStrength
    CROSCARMELLOSE SODIUM (UNII: M28OL1HH48)  
    HYDROXYPROPYL CELLULOSE (1200000 WAMW) (UNII: U3JF91U133)  
    LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)  
    SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
    POLYETHYLENE GLYCOL (UNII: 3WJQ0SDW1A)  
    POLYVINYL ALCOHOL (UNII: 532B59J990)  
    TALC (UNII: 7SEV7J4R1U)  
    TITANIUM DIOXIDE (UNII: 15FIX9V2JP)  
    Product Characteristics
    Colorwhite (white or almost white) Scoreno score
    ShapeCAPSULE (capsule-shaped) Size14mm
    FlavorImprint Code C32
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC: 0527-2248-3230 in 1 BOTTLE; Type 0: Not a Combination Product06/02/2020
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA21306906/02/2020
    FEBUXOSTAT 
    febuxostat tablet
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC: 0527-2244
    Route of AdministrationORAL
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    FEBUXOSTAT (UNII: 101V0R1N2E) (FEBUXOSTAT - UNII:101V0R1N2E) FEBUXOSTAT40 mg
    Inactive Ingredients
    Ingredient NameStrength
    HYDROXYPROPYL CELLULOSE (1200000 WAMW) (UNII: U3JF91U133)  
    LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)  
    SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
    POLYETHYLENE GLYCOL (UNII: 3WJQ0SDW1A)  
    POLYVINYL ALCOHOL (UNII: 532B59J990)  
    TALC (UNII: 7SEV7J4R1U)  
    TITANIUM DIOXIDE (UNII: 15FIX9V2JP)  
    CROSCARMELLOSE SODIUM (UNII: M28OL1HH48)  
    Product Characteristics
    Colorwhite (white or almost white) Scoreno score
    ShapeROUND (round shaped) Size9mm
    FlavorImprint Code C33
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC: 0527-2244-3230 in 1 BOTTLE; Type 0: Not a Combination Product06/02/2020
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA21306906/02/2020
    Labeler - Lannett Company, Inc. (002277481)
    Establishment
    NameAddressID/FEIBusiness Operations
    Sunshine Lake Pharma Co., Ltd.545391443manufacture(0527-2244, 0527-2248)
    • © 2024 FDA.report
    This site is not affiliated with or endorsed by the FDA.