• Most powerful uric-acid-lowering drug available
• Works in CKD stage 3–4 without dose adjustment
• Faster tophi dissolution than allopurinol
• Once-daily simple lifelong control
• First choice when allopurinol fails or is not tolerated

1. One Zurig 40mg tablet every morning
2. Swallow whole with water
3. Continue lifelong (gout is a chronic disease)
4. Doctor may increase to 80mg after 2–4 weeks if uric acid still >6 mg/dL

Q1: Why choose febuxostat 40mg over allopurinol?
A1: 2–3× more powerful, works even in moderate–severe kidney disease without dose reduction, and safer in patients with allopurinol allergy.

Q2: How fast do tophi disappear?
A2: Visible shrinkage starts in 3–6 months; many tophi resolve completely within 1–2 years at <5 mg/dL target.

Q3: Can I stop once uric acid is normal?
A3: No – stopping causes rapid rebound and severe flare; this is lifelong therapy.

Q4: Is 40mg the usual starting dose?
A4: Yes – guidelines now recommend starting at 40mg (not 80mg) for better tolerability and same final efficacy.

Q5: Any heart risk?
A5: Slightly higher CV risk vs allopurinol in one older study; current guidelines still recommend it as first-line in CKD or allopurinol intolerance.

• Take once daily – with or without food
• Start low-dose colchicine or NSAID for first 3–6 months to prevent mobilisation flares
• Monitor liver function at 2 & 4 months
• Caution in severe heart failure or history of heart attack/stroke
• Keep away from children