Barif 40 mg

Description

Indications
Barif tablets are prescribed for the chronic management of hyperuricemia in patients diagnosed with gout. However, Barif is not intended for the treatment of asymptomatic hyperuricemia.

Note: Always use as directed by a registered medical professional.

Pharmacology
Barif contains Febuxostat, a non-purine, selective inhibitor of xanthine oxidase (XO). This enzyme plays a crucial role in producing uric acid. By inhibiting XO, Febuxostat reduces serum uric acid levels. Febuxostat targets the breakdown of hypoxanthine to xanthine, and subsequently to uric acid, effectively lowering uric acid levels in the blood. Unlike other treatments, Febuxostat does not interfere with other enzymes involved in purine and pyrimidine metabolism at therapeutic doses.

Dosage & Administration

• Initial Dosage: Start with one 40 mg tablet of Febuxostat once daily. If after 2 weeks the serum uric acid level is still above 6 mg per dL, the dose should be increased to 80 mg once daily. If required, after 2-4 weeks, a further increase to 120 mg per day may be considered.
• Tumor Lysis Syndrome: For this condition, the recommended dosage is 120 mg once daily, starting 2 days before initiating cytotoxic therapy, continuing for a minimum of 7 days (treatment duration may extend to 9 days based on clinical evaluation).
• Gout Flares: Upon starting Febuxostat, gout flares may occur due to changes in uric acid levels and mobilization of urate from tissue deposits. To prevent flares, prophylactic therapy with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is advised. If a flare does occur, continue the treatment with Barif and manage the flare as necessary.
• Renal Impairment: No dose adjustments are necessary for patients with mild to moderate renal impairment.
• Hepatic Impairment: Similarly, no dosage adjustment is needed in patients with mild to moderate hepatic impairment.
• Pediatric Use: The safety and efficacy of Febuxostat in children under 18 years of age have not been established.

Note: Always use as directed by a registered medical professional.

Drug Interactions

• Mercaptopurine/Azathioprine: Do not combine with Barif, as it may lead to increased plasma concentrations of these drugs, increasing the risk of toxicity.
• Rosiglitazone and CYP2C8 substrates: No dose adjustment is required when used with Barif.
• Naproxen and other inhibitors of glucuronidation: There is no need for dose adjustments when co-administering Barif with naproxen.
• Inducers of glucuronidation: Strong inducers of UGT enzymes may increase the metabolism of Barif, potentially reducing its effectiveness. Regular monitoring of serum uric acid is recommended.
• Colchicine, Indometacin, Hydrochlorothiazide, Warfarin: No dose adjustments are necessary for these medications when taken with Barif.
• Antacids: Antacids containing magnesium hydroxide or aluminium hydroxide may delay the absorption of Barif by approximately 1 hour, but this does not significantly affect its overall effectiveness.

Contraindications
Barif is contraindicated in patients being treated with azathioprine, mercaptopurine, or theophylline.

Side Effects
Common side effects include gout flares, liver function abnormalities, nausea, diarrhea, headache, rash, and edema. Most adverse effects are mild or moderate in severity, though rare but serious hypersensitivity reactions may occur.

Pregnancy & Lactation
Barif falls under Pregnancy Category C. There are no well-controlled studies in pregnant women. It should only be used during pregnancy if the potential benefits justify the potential risks to the fetus. It is unknown whether Barif is excreted in breast milk, so caution is advised when administering to nursing mothers.

Precautions & Warnings

• Gout Flare: Gout flares are common during the initiation of any anti-hyperuricemic therapy, including Barif. If a flare occurs, treatment with Barif should not be discontinued. Prophylactic treatment with NSAIDs or colchicine is recommended for up to 6 months to prevent flares.
• Cardiovascular Events: Clinical trials show that Barif may be associated with an increased rate of cardiovascular thromboembolic events compared to allopurinol. Regular monitoring for signs of myocardial infarction or stroke is advised.
• Liver Enzyme Elevation: Liver enzyme elevations may occur in some patients on Barif. Liver function tests should be periodically monitored during treatment.

Overdose Effects
Febuxostat has been tested in healthy individuals up to 300 mg daily for 7 days without significant toxic effects. In case of overdose, supportive care is necessary, and immediate medical attention should be sought.

Therapeutic Class

• Anti-hyperuricemic Drugs, Gout Treatment

Storage Conditions
Store below 30°C, protected from light and moisture. Keep out of reach of children.