From the Guidelines
NSAIDs are not contraindicated in patients with kidney stones and are actually considered first-line treatment for renal colic pain. Medications like ibuprofen (600-800mg every 6-8 hours), naproxen (500mg initially, then 250mg every 6-8 hours), or ketorolac (30-60mg IM or 30mg IV initially, then 15-30mg every 6 hours) are effective options. NSAIDs work by inhibiting prostaglandin synthesis, which reduces inflammation, pain, and ureteral smooth muscle tone, potentially facilitating stone passage. However, caution is warranted in patients with pre-existing kidney disease, as NSAIDs can reduce renal blood flow and glomerular filtration rate, potentially worsening kidney function, as noted in a study published in the American Family Physician 1.
Some key points to consider when using NSAIDs in patients with kidney stones include:
- Using the lowest effective dose for the shortest duration necessary to minimize the risk of adverse effects
- Monitoring renal function and adjusting the dose or discontinuing the medication if necessary
- Avoiding the use of NSAIDs in patients with severe kidney disease or those taking certain medications that may increase the risk of kidney damage
- Encouraging adequate hydration to help with stone passage, as recommended by the American College of Physicians 1
It's also important to note that alternative pain management options, such as acetaminophen or opioids, may be necessary for patients with contraindications to NSAIDs. Ultimately, the decision to use NSAIDs in patients with kidney stones should be made on a case-by-case basis, taking into account the individual patient's medical history, current health status, and potential risks and benefits.
From the Research
NSAIDs and Kidney Stones
- The use of NSAIDs in patients with kidney stones is a topic of debate, with some studies suggesting that they may be beneficial for pain management, while others raise concerns about their potential nephrotoxic effects 2, 3, 4, 5, 6.
- A study published in 2005 found that NSAIDs were effective in reducing pain in patients with acute renal colic, with a lower incidence of adverse events compared to opioids 4.
- However, another study published in 2023 found that both systemic and topical NSAIDs were associated with an increased risk of acute adverse kidney outcomes in patients with chronic kidney disease 5.
- A 2025 review of NSAIDs for acute renal colic found that they may reduce pain compared to placebo, but the evidence is uncertain regarding their potential harms 6.
- The same review found that different NSAIDs may have varying effects on pain relief and adverse events, with some NSAIDs being more effective or having fewer adverse events than others 6.
Potential Risks and Benefits
- The potential benefits of NSAIDs for pain management in patients with kidney stones must be weighed against their potential risks, including nephrotoxicity and adverse kidney outcomes 2, 3, 5.
- Patients with kidney disease or those at risk for kidney disease should be cautious when using NSAIDs, and their use should be carefully monitored by a healthcare provider 2, 3.
- Alternative pain management options, such as opioids or other non-NSAID analgesics, may be considered for patients with kidney stones, but their use should also be carefully monitored due to their potential risks and side effects 4, 6.
Route of Administration
- The route of administration of NSAIDs may also play a role in their potential risks and benefits, with topical NSAIDs potentially having a lower risk of adverse kidney outcomes compared to systemic NSAIDs 5.
- Intravenous NSAIDs may be similar to intramuscular NSAIDs in terms of pain relief, but may be better than rectal NSAIDs in reducing the need for rescue medication 6.