7.4.3 Drugs used in urological pain

General Notes

  • See NICE guideline NG118 on Renal and Ureteric stones: Assessment and Management.
  • The acute pain of ureteric colic may be relieved with diclofenac by injection or as suppositories and compares favourably with pethidine; other NSAIDs are occasionally given by injection.
  • Lidocaine gel is a useful topical application in urethral pain or to relieve the discomfort of catheterisation (see BNF Chapter 15).
  • Tamsulosin is sometimes prescribed off-label [unlicensed indication] to hasten the passage of ureteral stones and decrease the severity and duration of renal colic.

Alkalinisation of urine

ChoiceDrugDosage
1st choicePotassium citrate mixture BP (potassium citrate oral solution containing potassium citrate 30%, citric acid monohydrate 5% in a suitable vehicle with a lemon flavour)Dose: 10ml 3 times daily well diluted with water

Prescribing Notes

  • Potassium citrate may relieve discomfort in mild urinary tract infections.
  • Proprietary brands of potassium citrate and sodium citrate are on sale to the public for relief of discomfort in mild urinary tract infections.
  • Sodium bicarbonate is used as a urinary alkalising agent in some metabolic and renal disorders.

Caution

  • Caution is required when using either potassium or sodium citrate in patients with cardiac disease or renal impairment.