Cardiovascular safety of febuxostat

Comparing the risks with those of allopurinol

  • Like patients with diabetes, patients with gout represent, in absolute terms, a large group of patients at clearly increased cardiovascular risk. It is clinically relevant to know the cardiovascular safety of the drugs that they might have to use for the rest of their lives.
  • Allopurinol and febuxostat are both indicated for chronic use by patients with gout who experience an unacceptable burden of symptoms like painful gout attacks or subcutaneous nodules formed by deposition of uric acid crystals (tophi).
  • Recent research has found that the cardiovascular safety of febuxostat appears to be equivalent to that of allopurinol. The study did, however, have various limitations.
  • The elevated risk of death, including mortality due to cardiovascular disorders, which had in fact already been suspected, is an additional argument for opting for allopurinol rather than for febuxostat.
  • In all, allopurinol, a drug with which decades of experience have been gained, remains the drug of first choice for lowering uric acid levels. The costly drug febuxostat, which has only been registered in the Netherlands since 2014, should for now only play a limited role, in case of failure or adverse side effects of allopurinol. 

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The literature refers to the Dutch text


  • dr H.J.E.M. Janssens, mw drs M.A.E. Nieuwhof