American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for hyperuricemia in a patient allergic to allopurinol?

1. Febuxostat

2. Probenecid

3. Colchicine

4. Uricosuric agents

The correct answer is: Febuxostat

When considering treatment options for hyperuricemia, especially in patients who are allergic to allopurinol, febuxostat emerges as a preferred alternative. Febuxostat is a xanthine oxidase inhibitor, similar to allopurinol, but it presents a different chemical structure which often makes it suitable for patients who experience allergic reactions or intolerances to allopurinol. Febuxostat effectively lowers uric acid levels and is particularly beneficial for patients who cannot tolerate allopurinol due to hypersensitivity reactions, such as skin rashes or other allergic manifestations. It works by inhibiting the production of uric acid without the same risk of cross-reactivity that might be present when using allopurinol. This option is preferred over uricosuric agents, which can be less effective in patients with kidney dysfunction, and probenecid, which carries the risk of causing kidney stones and may not be suitable for all patients. Colchicine, while useful in acute gout flares, does not address hyperuricemia directly. In summary, febuxostat offers an effective and safe alternative for managing hyperuricemia in those with an intolerance to allopurinol, making it the most appropriate choice in this scenario.