Kidney Stones – Ouch!

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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This too shall pass—or will it?

Kidney stones are painful. Childbirth painful. In addition to pain meds, how can we help you pass that stone quickly? Now we may know.

Kidney stones (nephrolithiasis) occur in 5% – 12% of the population and frequently on Friday afternoons. Eighty percent of them are calcium oxalate stones and interestingly, 20% are in the ureter at the time you come to the ER for help. They all hurt.

You are often on your own at home to deal with them, as we have become more comfortable managing stones for outpatients, but you need to know what medications you need.

Stones that are less than 5 mm in size have an 85% chance of passing on their own. Those that are 5 – 10 mm have a 50% chance, and those larger than 8 mm have a 20% chance.

Generic Flomax (tamsulosin), will help you pass stones less than 10 mm in size, especially if your stone is already far down in the ureter.

But sometimes the stones are more stubborn—is there anything else we can do?

A recent study looked at adding prednisolone to tamsulosin to help you pass a stone. Here is what we learned:

Tamsulosin 0.4 mg + 5 mg of prednisolone (equivalent to 5 mg of prednisone) was compared to watchful waiting (all patients received intravenous Toradol (ketorolac) as needed for pain).

The group of folks with kidney stones who received the tamsulosin + prednisolone passed the stone on their own 70% of the time (compared to only 32% in the group who did nothing) and had less pain.

These are two cheap, safe oral medications. If you are being tortured by a stone, this is a no-brainer.

Dr O.

You can find 30 capsules of tamsulosin for under $20 at many pharmacies with a coupon or using a pharmacy membership program. Prednisolone is under $10 for 30 tablets in most cases, sometimes as low as $5. Both medications should be covered by most insurance plans under Tier 1, meaning you’ll pay only your lowest copay.

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