OBJECTIVE To assess the efficacy and safety of benzbromarone in patients with renal impairment and severe tophaceous gout (despite receiving optimal conventional therapy). METHODS Six patients with refractory gout (despite optimal therapy) were treated with benzbromarone. Uric acid levels and number of gout attacks were recorded monthly. Adverse events to medications were also recorded. RESULTS After 1 year of treatment with benzbromarone, average uric acid level reduced from 0.61 mmol/L to 0.46 mmol/L. Repeated measures tests on the changes in uric acid were clinically significant (p=0.01). The frequency of acute attacks of gout was reduced from 16 (8-20) to 7.3 (1-16); p=0.01. None of the patients reported adverse events with the medications. There were no acute flares resulting from initiation of medications. CONCLUSIONS Benzbromarone is effective in lowering uric acid levels and in reducing the number of acute attacks of gout in patients who have failed optimal treatment. Making this drug more readily available will increase our therapeutic choices for urate reduction and help decrease the morbidity associated with gout.