Kidney Stones - Medications

Highlights	Risk Factors	Other Treatments
Introduction	Diagnosis	Resources
Complications	Treatment	References
Causes	Prevention
Symptoms	Medications

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Medications

Diuretics. Diuretics are commonly used in the treatment of high blood pressure and other disorders to eliminate fluid and sodium from the body. Low doses of diuretics known as thiazides are sometimes used to reduce the amount of calcium released by the kidneys into the urine. In fact, a major analysis comparing a number of agents reported that only thiazides protected against kidney stones. Some thiazides include hydrochlorothiazide (Esidrix, HydroDiuril), chlorothiazide (Diuril), trichlormethiazide (Metahydrin, Naqua), and chlorthalidone (Hygroton). Thiazides, however, also cause potassium loss, which, in turn, reduces citrate levels and can increase the risk for stones. Potassium citrate should therefore be taken along with a thiazide to prevent citrate loss. Amiloride (Midamor) is a potassium-sparing diuretic, which may be used if a thiazide is not effective, and offers an extra benefit by reducing potassium loss.

Citrates. Citrate salts are often given to people with calcium oxalate or uric acid stones:

Potassium magnesium citrate is a combination available over the counter, which is proving to be very beneficial in preventing kidney stones and even a better option than the more commonly used potassium-only formulations. In one study, it reduced the risk for kidney stone recurrence by 85%.
Potassium citrate (K-Lyte, Polycitra-K, Urocit-K) elevates citrate levels in the urine and reduces calcium excretion and recurrence of stones regardless of the cause of low citrate levels. It is given as a sole treatment to people with normal urine calcium levels. Between 70% and 75% of patients with recurrent stones have experienced on-going remission with potassium citrate therapy. Some people cannot tolerate it because of digestive side effects.
Magnesium citrate (Citroma, Citro-Nesia) may be useful for people who develop calcium stones from impaired intestinal absorption due to small bowel disease.

None of these products should be used by people with struvite stones, urinary tract infections, bleeding disorders, or kidney damage. Patients who take citrate supplements containing potassium should not take any other medications that either contain the mineral or prevent its loss (such as so-called potassium-sparing diuretics). People with peptic ulcers should avoid them or discuss using non-tablet forms with their doctor.

Phosphates. Phosphates help reduce bone resorption (the breakdown of bone that releases calcium into the bloodstream) and are also involved in reabsorption of calcium from urine by the kidney. Certain phosphate compounds may be helpful.

Neutral (nonacidic) sodium or potassium phosphate (K-Phos, Neutral, Neutra-Phos) is usually taken four times a day after meals to prevent kidney stones unless otherwise directed by the doctor. Diarrhea is a possible side effect.
Cellulose phosphate (Calcibind) binds calcium in the intestine. It is recommended only for severe hypercalciuria caused by excessive absorption of calcium from the intestinal tract that is associated with recurrent calcium stones. There is a risk with this drug, however, of increasing oxalate levels and decreasing magnesium levels. Restricting dietary oxalates, calcium, and ascorbic acid and taking magnesium supplements may help offset these risks. It may also cause bloating.