Is alfuzosin (alpha-1 adrenergic receptor blocker) used for the treatment of nephrolithiasis (kidney stones)?

From the Guidelines

Alfuzosin can be used to facilitate the passage of kidney stones, particularly those less than 10mm in size, by relaxing the smooth muscles in the urinary tract. This is based on the evidence that alpha-blockers, such as alfuzosin, can increase the likelihood of spontaneous stone passage and reduce stone-passage time and pain 1. The mechanism of action of alfuzosin involves blocking alpha-1 receptors, which reduces muscle tone and spasm in the ureter, potentially decreasing pain and increasing the likelihood of spontaneous stone passage. Some key points to consider when using alfuzosin for kidney stones include:

• The typical dose is 10mg once daily, usually taken after the same meal each day
• Alfuzosin may be used as an alternative to other alpha-blockers like tamsulosin
• Alpha-blockers are an adjunctive therapy for kidney stones and not a replacement for other treatments such as pain management, hydration, or surgical interventions for larger stones
• Side effects may include dizziness, headache, and postural hypotension, so it's advisable to take the first dose at bedtime and avoid situations requiring alertness until you know how the medication affects you According to the American Urological Association guideline, patients with uncomplicated ureteral stones ≤10 mm should be offered observation, and those with distal stones of similar size should be offered medical expulsive therapy (MET) with alpha-blockers 1. Overall, alfuzosin can be a useful adjunctive therapy for facilitating the passage of smaller kidney stones, but it's essential to weigh the benefits and risks and consider individual patient factors when making treatment decisions.

From the Research

Alfuzosin for Kidney Stones

• Alfuzosin has been studied as a medical expulsive therapy for ureteral stones, with several randomized controlled trials reporting its use 2, 3, 4, 5.
• The studies suggest that alfuzosin is effective in increasing the stone expulsion rate and shortening the stone passage time for uncomplicated distal ureteral stones 2, 3, 4, 5.
• A systematic review and meta-analysis found that alfuzosin provided a significantly higher stone-free rate than control treatments and a shorter stone expulsion time 2.
• Another study found that alfuzosin improved the patient discomfort associated with stone passage and decreased the time to distal ureteral stone passage, but did not increase the rate of spontaneous stone passage 4.
• Alfuzosin has also been studied as an adjunctive medical therapy after extracorporeal shock wave lithotripsy (ESWL) for renal stones, with one study finding that it increased the expulsion rates of stones, decreased time to expulsion, and decreased need for analgesia during stone passage 6.

Efficacy and Safety

• The studies suggest that alfuzosin is safe and effective for the treatment of ureteral stones, with a low incidence of adverse side-effects 2, 3, 4, 5.
• One study found that alfuzosin had a higher complication rate compared to control treatments, but the adverse effects were similar to those of tamsulosin, another alpha blocker 2.
• Another study found that alfuzosin therapy was tolerable with only minor adverse effects, such as headache, dizziness, mild postural hypotension, and rhinitis 5.

Comparison to Other Treatments

• Alfuzosin has been compared to tamsulosin, another alpha blocker, with one study finding that there was no significant difference in terms of stone-free rate and stone expulsion time between the two treatments 2.
• Alfuzosin has also been compared to standard conservative therapy, with one study finding that it provided a significantly higher stone-free rate and a shorter stone expulsion time 2.