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.


25 Responses to The next step: Medications for kidney stones

  1. Cinnie says:

    I have had stones for over 40 years numerous surgeries etc I was prescribed potassium citrate but my pharmacy cannot get them from the manufacturer is there an alternative as its a lifelong medication that’s required thank you for any help

  2. Jeremy says:

    You guys are pansies. I’m 29 and I pass stones over 15mm no joke. My last one weighed this much with this composition:

    Calculi Description See Below
    Calcium Oxalate Dihydrate (Weddellite) 20%
    Calcium Oxalate Monohydrate (Whewellite) 80%
    Weight 0.1150 g g

    My best advice for you is to start shooting heroin or doing oxycontin the second you start experiencing the kidney stone. If not you will hate life.

    • Hartley says:

      So you’re a junkie who is trying to justify your habit by attributing it to being able to pass large kidney stones.

  3. Toby says:

    I have passed dozens of stones starting at nineteen. I was getting about one a month most of which I passed until I was put on hydrochlorathyazide and potassium. After the second surgery a contracted urinary sepsis and almost died. Although the meds have helped dramatically I still occasionally get a stone. I drink large amounts of water, lemonade and cranberry juices and only get about one a year that is passable. A good side effect if the hydrochlorathyazide is my blood pressure is perfect! If you’re on this Web site I can empathize. We all can jike about it after the fact but take care if yourself as it can become serious. God bless!

  4. DeeAnne says:

    I have had numerous stones for the past 35 years. About 7 years ago, after getting a stone stuck after lithotripsy, My urologist wanted me to take prescription drugs and I did not want to do that. I asked my urologist why I kept getting stones. She finally said she did not know, and sent me to a Nephrologist. He did several tests and figured out that I produced a lot of calcium. He put me on Magnesium, plus protein tablets. Not over the counter, but also not by presription. I order them directly from company as local stores quit handling them. Since I have been taking them, stones dissolved on their own and I have not had any new stones. If you keep getting them stones, you might consider going to a nephrologist and see if they can figure it out for you. Hope this helps someone.

    • D.L. Myers says:

      Will you please post what specific magnesium and protein tablets he had you try. I am on a fixed income and my doctors just keep increasing the amount of
      the prescription medications which drives up the cost and ha not resulted in any further decrease in the number of calcium stones I am producing. The protein tablets could also help me get enough protein. I hope you can/will do this for me as well as others might also benefit. Thank you in advance.

  5. Stacy says:

    I was getting kidney stones about every two years & they became to big to pass so after alot of surgeries I found a awesome Urologist that put me on potassium citrate & I haven’t had a kidney stone in ten years. He said if I quit taking them my stones would return so I’ll probably have to take them forever but it’s worth it.

  6. Matt says:

    When I have an acute attack I have good results pounding water with squeezed concentrated lemon juice, as well as the use of the natural diuretic chanca piedra. You have to drink a gallon or so of water a day when you have an issue.

    I also take magnesium citrate and potassium citrate, but eventually had to take low dose hydrochlorothiazide to dramatically reduce stone formation.

  7. Bamidele says:

    I was diagnosed for a kidney stone of the right side measuring 5.5mm and the left side measuring 7.1mm and 3.3mm. Please please and please what can i do to get rid of this.

  8. Bamidele says:

    Please where can i get the beet?

  9. Jackie says:

    I have a 6mm kidney stone. The Urologist put in a stent and I am miserable. He won’t give me pain meds. Did I mention that I am miserable? Surgery is this Tuesday.

    • Julie says:

      Sounds like something my urologist would do.I’ve suffered having double stets (both sides) and had to wait 6 weeKS for Lithotripsy and meanwhile work…I was miserable. .Hopefully never happens again as many times with my large stones I’ve been hospitalized with septic infection from them.

      • Lynn says:

        Raising your citrate level over 800 mg per day has shown to help reduce stone formations. Try Stone Away. It’s 100% all natural. My brother uses it, and some family members too. I also have a handful of friends who use it and it’s helped every one of them. Stone Away. Contact the owners on their FB page and they might even send you a free bottle to start taking. It will help.

  10. 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.

  11. 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..)

    • Julie says:

      Been there done that 5 times in the last 4 years. Twice hospitalized with Septic infection. Mine usually require stets because they won’t pass and block the tube to the bladder. My last experience was a year ago and had to wait weeks for the lithotripsy was so miserable. Also never actually saw my labs..I think my doc knows my cause but is in it for money PERIOD!!

  12. 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.

  13. 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.

  14. 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

      • Glenn Jones says:

        Ditto–they wanted to do a $23,000 “simple outpatient procedure” to help me pass a stone in my ureter, but I went home and started drinking the 50-50 fresh lemon juice & EVOO, and the pain was gone in a couple of hours.

    • 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!

    • allgood says:

      beet juice works wonders–or eat 1 can of beets drink the fluid–twice a day–beets acidify your urine and dissolve the stone enough to pass it on. this has worked for me and several friends

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