The next step: Medications for kidney stones

In some patients, the addition of a daily medicine may be recommended to decrease the risk of future stones. In clinical trials, these medications have been shown to significantly reduce the number of stones re-developed in patients with a known history of stones.

While many patients are reluctant to take medications and prefer to focus on dietary modification, medications can be a good option, especially in individuals who frequently develop new stones.

Common preventative medications

Three common medications are used in the prevention of stones.

Potassium Citrate

Useful for: Low urinary citrate (hypocitraturia), renal tubular acidosis, uric acid stones, calcium oxalate stones, cystine stones.

How does it work: Potassium citrate has two beneficial effects in stone formers. It increases urinary citrate, which acts a direct inhibitor of stone formation of calcium oxalate stones. It also increases urine pH, making urine more alkaline which reduces uric acid stone formation.

How well does it work: In four randomized studies with a total of 227 patients on citrate medications or placebo, treatment reduced the recurrence of stones from 65% to 46.5% after at least one year of treatment. In two randomized studies with a total of 104 patients who were treated with citrate medication after stone surgery, the recurrence rate of stones was 72.5% in those on placebo and 34% in those on medication. (Mattle and Hess, Urol Res, 2005)

Side effects: Potassium citrate can be given in powder form for mixing in liquid, in liquid form, and as a tablet. The primary side effects of this medication is gastric irritation, less so with the tablet which contains potassium citrate in a wax matrix.


Useful for: High urinary calcium (hypercalciuria), calcium stones.

How does it work: Thiazides including hydrochlorothiazide, chlorthalidone, and indapamide, stimulate calcium reabsoprtion in the kidney, reducing the concentration of calcium in the urine.

How well does it work: Randomized trials have found a significant decrease in stone formation with the use of thiazides. In a study of 50 stone formers who received either placebo or hydrochlorothiazide 25 mg twice a day, 75% of those on treatment remained stone free as compared to 45% of the placebo group over three years. Those on treatment also had a longer stone free interval (Laruem and Larsen, Acta Med Scand, 1984).

Side effects: Thiazide treatment can cause a decrease in blood potassium levels and can also can reduce citrate levels in the urine. Therefore, potassium citrate is sometimes given with thiazides to correct both the low potassium and citrate that can occur with its use. Fatigue and dizziness and other side effects have also been reported by patients on thiazide treatment.


Useful for: Elevated urine uric acid (hyperuricosuria), uric acid stones, calcium stones

How does it work: Allopurinol interferes with the conversion of xanthine (a purine) to uric acid with a resulting decrease in uric acid levels in urine. It is more commonly used in patients with gout. Purines are found at high concentrations in meats, seafood, and beer. Uric acid in urine can directly form uric acid stones or can act as an promoter of calcium oxalate stones.

How well does it work: In a randomized study of 60 patients with high urinary uric acid and a history of calcium stones, 31% of those on treatment developed new stones over three years compared to 58% of those on placebo. Those on treatment also had a longer time before re-developing a stone (Ettinger et al, NEJM, 1986).

Side effects:Allopurinol can cause GI upset, diarrhea, and drowsiness in addition to other potential side effects.

Less commonly used  preventative medications

Penicillamine (Cuprimine)

Penicillamine is used in patients with a history of cystine stones. It binds the cystine molecule, making it more soluble in urine. This medication unfortunately has a high rate of serious side effects and few patients can tolerate it.

α-mercaptopropionylglycine (Thiola)

This medication is also used for patients with cystine stones. It works in a similar fashion to D-penicillamine in that it binds cystine making it more soluble. However, it has lower side effects, making tolerability better.

Sodium cellulose phosphate

In patients with high calcium absorption, sodium cellulose phosphate acts as a nonabsorbable binding resin which binds calcium in the gut, reducing its absorption. However, this medication had a high rate of gastrointestinal side effects and it is now rarely used.


7 Responses to The next step: Medications for kidney stones

  1. Alan Gilbert says:

    If your urologist suggested that then that’s fine but a word of caution to others who might want to try this. I had to go to hospital recently where they diagnosed a kidney stone. I was given a Flomax tablet to see if the stone would come out naturally rather than them having to intervene (which they had to do eventually). The tablet caused a huge drop in my blood pressure to a point where I nearly passed out. In fairness there were other contributing factors e.g. I was stressed and in a fair amount of discomfort.

    I was prescribed Flomax after my stone was removed and I’ve been advised that it may cause me attacks of dizziness but my body will adjust to it. I’m currently taking the Flomax in the evening after a meal and I was told to avoid alcohol for the time being.

  2. Lily R. says:

    I’m wondering how many people who have had multiple lithotripsy surgeries for kidney stones (or just had multitudes of stones over time) found that the true cause of these was a parathyroid tumor/tumors? Was your serum (blood) calcium elevated in low 10’s. but then go back into “normal” range? Was your intact PTH ever ‘inappropriately normal’? Was your urinary calcium high? What significance (if any) did ‘ionized’ calcium have? (I’m not sure what the significance of mine meant – it was 5.5, 5.4 – always up in that range..)

  3. Mandy says:

    I too have had so may stones that I have lost count. Mostly when I was pregnant with my children. Tomorrow I go in to have my stones crushed by shockwaves for the second time since March. I was told they were too large to pass on their own. I also was given Flomax to dialate the ureters. It really helped reduce the pain. The pain is caused by the stone traveling through the ureters (scraps along the walls). Also to help reduce pain, sit a tub of water as hot as you can stand it. It works! I have done that several times. Then I would place a heating pad on the side that hurt after. Drink A LOT of fluids! Lemon Juice water. Guzzle it. You have to flush it out. Take care. I would go into the doctor if you have not passed it within a couple of days. You don’t want any blockage to your kidney due to the stone.

  4. John Kelleher says:

    Deepak, If you have a 5mm stone I would think you have seen a doctor already. I recently had a stone removed and they do it with a catheter that is inserted through the penis, bladder, and then into the ureter where the stone can be broken up and removed. They do have another method where they blast the stone with ultrasound and make it smaller so they can possibly pass on there own. Let us know how it turns out for you. Good Luck.

  5. deepak says:

    i have kidney stone in the left side of the kidney can i pass my kidney stone
    is there any quick treatment or surgery ??
    please help me out…
    Thank you

    • Badejo anthony says:

      You can pass your stone with treatment and in less or 2 weeks.first of all you need to take fluids more often and drink lemon juice morning and night with olive oil to make the stone pass through your ureter,.take 2 ounce of lemon fruit,squeeze it and mix the juice with 2 ounce of olive oil,drink it in the morning and night and you can try and get apple cider vinegar,it helps too…..good luck

    • Veronica says:

      Deepak- I have been in your position many times. My urologist believes that kidneystones under 6mm in size should try to be passed “naturally” if possible (if after a month it doesn’t pass then surgey or lithotripsy is needed). My body is is a stone making machine for some unknown reason despite potassium supplements and diet restrictions and I have passed so many stones in my life that I lost tract of the exact number long ago.
      There is only ONE thing that has ever worked for me (to pass stones naturally) and when it was first suggested to me by my urologist I thought it had to be a joke, but I had tried everything else and thought “why not?” and it worked to my astonishment. Two .4mg of Flomax (generic is called tamsulosin) and a six pack of beer drank as fast as possible. Yes it sounds ridiculous, but it works everytime (except for one exception when the stone was lodged in a way that required surgery). I hate beer, actually I hate the taste of all alcohol (yes really) so it might be possible that this method works especially well for me, I don’t know because I don’t even know anyone else who has ever had a kidneystone. My urologist explained the mechanics behind the how this method works but it was far too complicated for someone like me who doesn’t understand “doctor speech” so I had her say it so I could understand: basically the Flomax relaxes the muscles allowing the ureter to expand (become more flexible to accommodate a stone passage) and drinking several beers quickly makes you have to “pee like a racehorse”.
      I know it sounds ridiculous but if you still haven’t passed the stone I would give it a try (even if you are unable toget Flomax) because it works for me and it can’t hurt to try… Hang in there, I know the pain you must be in… Good luck!

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