The Scottish Medicines Consortium (SMC) has published advice on the use of febuxostat (Adenuric®) for the treatment of chronic hyperuricaemia in conditions where urate deposition has already occurred (including a history, or presence, of tophus and/or gouty arthritis).  It is accepted for restricted use within NHS Scotland for this indication, in cases where treatment with allopurinol is inadequate, not tolerated or contraindicated.

The drug advice (see link below) notes that febuxostat is superior to allopurinol 300mg daily in reducing serum uric acid to <6mg/dL, in patients with hyperuricaemia and gout.  The economic case was demonstrated for second line use of febuxostat in patients who had an inadequate response to allopurinol, or when allopurinol is contraindicated or not tolerated.