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Pharmacological Management of Renal Colic in the Older Patient

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Abstract

Renal colic affects up to 12% of the population. Initial management of most patients is expectant. Acute symptom management of renal colic is best accomplished with a combination of parenteral opioids and NSAIDs. The elderly patient with a kidney stone should be screened for contraindications to NSAID therapy, such as renal failure or previous peptic ulcer disease. Use of parenteral opioids is often necessary during the acute setting, and downward-adjusted doses and monitoring are necessary to prevent associated confusion and respiratory depression. Novel therapy with desmopressin may also be effective for symptom control at the initial presentation, without the adverse effects of opioids or NSAIDs. However, use of desmopressin in the elderly must be undertaken cautiously, given the potential adverse effects of this agent. Many small, distal ureteral stones are treated initially with watchful waiting for the first 2–4 weeks after presentation. The patient should have effective, non-parenteral analgesics for use at home. Included in these agents are oral or suppository NSAIDs and oral opioids. Medical expulsion therapy with α-adrenoceptor antagonists or calcium channel antagonists is efficacious. α-Adrenoceptor antagonists such as the α1A/1D-selective tamsulosin are well tolerated in the elderly and increase the rate of spontaneous stone passage by approximately 50% for small distal stones. These agents also appear to decrease the severity of renal colic. Corticosteroids and calcium channel antagonists are also effective but their use in the elderly is not recommended as first-line therapy.

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Acknowledgements

No sources of funding were used to assist in the preparation of this article. Dr Teichman has acted as a consultant to Ortho-McNeil, Origen Therapeutics and Omeros, and has received honoraria and grants from Ortho-McNeil. The authors have no conflicts of interest that are directly relevant to the content of this article.

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  1. Department of Urologic Sciences, and Division of Urology, University of British Columbia, Providence Healthcare, Vancouver, British Columbia, Canada

    Blayne K. Welk &  Joel M. H. Teichman

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Welk, B.K., Teichman, J.M.H. Pharmacological Management of Renal Colic in the Older Patient. Drugs Aging 24, 891–900 (2007). https://doi.org/10.2165/00002512-200724110-00002

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