What is the treatment plan for a patient with kidney stones prescribed Rowatinex (Phenazopyridine)?

Clarification: Rowatinex is NOT Phenazopyridine

Rowatinex is a plant-derived terpene preparation used as adjunctive therapy to facilitate stone fragment passage after lithotripsy, NOT phenazopyridine (which is a urinary analgesic that can actually cause stones with overuse). 1

Treatment Plan for Kidney Stone Patients Prescribed Rowatinex

Primary Indication and Role

Rowatinex should be used as adjunctive lithokinetic therapy following extracorporeal shock wave lithotripsy (ESWL) to accelerate stone fragment clearance, not as primary treatment for intact kidney stones. 2, 3

• Rowatinex contains essential oils with anti-inflammatory and lithokinetic (stone-moving) properties that facilitate fragment passage after stone fragmentation 2
• The medication works through antispasmodic effects that increase diuresis and promote clearance of stone fragments 3

Dosing and Administration

• Administer Rowatinex 100 mg orally three times daily starting in the perioperative period around ESWL 4
• Continue therapy for at least 2-4 weeks post-procedure to maximize fragment clearance 3, 4

Expected Outcomes

• At 2 weeks post-ESWL, Rowatinex significantly increases stone-free rates (18% vs 4% with placebo, p=0.02), accelerating fragment passage 4
• For stones ≥3 mm, Rowatinex achieves 61% expulsion rate versus 28% with placebo 5
• By 4 weeks, the overall stone-free rate difference becomes less significant, but early clearance reduces complication risk 4

Concurrent Standard Management Required

Rowatinex is supplementary only—you must provide guideline-directed primary kidney stone management concurrently:

Acute Pain Management

• Administer intramuscular diclofenac 75 mg as first-line analgesic for renal colic, which provides superior pain relief within 30 minutes 6, 7, 8
• Reserve opioids (hydromorphone, pentazocine, tramadol) only when NSAIDs are contraindicated 6, 7

Medical Expulsive Therapy (MET)

• Prescribe alpha-blockers (tamsulosin, doxazosin, or terazosin) for uncomplicated ureteral stones ≤10 mm, particularly for distal stones >5 mm, which increases passage rates to 77.3% versus 54.4% without treatment 6, 8
• Maximum trial duration is 6 weeks to avoid irreversible kidney damage 6

Fluid Management

• Instruct patients to increase fluid intake targeting urine output of at least 2.5 liters daily to promote stone passage 7, 8
• Coffee, tea, wine, and orange juice are associated with lower stone risk; avoid sugar-sweetened beverages 7, 8

Diagnostic Workup

• Perform urinalysis with dipstick and microscopic evaluation to assess pH, infection, and crystal type 9, 7
• Obtain serum chemistries including electrolytes, calcium, creatinine, and uric acid 9, 7
• Order renal ultrasonography as first-line imaging to quantify stone burden 7, 8
• Obtain stone analysis when available to guide metabolic prevention strategies 7, 8

Stone Type-Specific Metabolic Management

Calcium Stones

• Offer thiazide diuretics (hydrochlorothiazide 25 mg twice daily or 50 mg once daily) for hypercalciuria 9, 7
• Prescribe potassium citrate for hypocitraturia to inhibit calcium phosphate crystallization 9, 7

Uric Acid Stones

• Potassium citrate is first-line therapy to alkalinize urine to pH 6.0-7.2, which can dissolve existing stones 6, 8
• Rowatinex may help stabilize urine pH within the 6.2-6.8 range, supporting metaphylaxis 3

Cystine Stones

• Increase fluid intake, restrict sodium/protein, and alkalinize urine to pH 7.0 with potassium citrate 6, 8

Monitoring and Follow-Up

• Obtain imaging within 7 days if stone has not passed to reassess stone burden 7
• Monitor for leukocyturia reduction, which Rowatinex has been shown to decrease 3
• Assess 24-hour urine parameters (calcium, uric acid, citrate, pH) to guide long-term prevention 3

Safety Profile

• No significant adverse effects or complications have been reported with Rowatinex, allowing for long-term administration 3, 4, 5
• The medication is well-tolerated and can be used for extended periods in metaphylaxis of recurrent stone formation 3

Critical Red Flags Requiring Urgent Intervention

• Sepsis with obstructing stone requires urgent decompression via percutaneous nephrostomy or ureteral stenting immediately—do not delay 6, 7, 8
• Anuria in an obstructed kidney mandates emergency intervention 6, 7
• Failure to respond to analgesia within one hour requires immediate hospital admission 7, 8

Common Pitfalls to Avoid

• Do not use Rowatinex as monotherapy—it is adjunctive only and must be combined with standard guideline-directed care 2, 3
• Do not confuse Rowatinex with phenazopyridine (Pyridium), which is a urinary analgesic that can cause stones with overuse 1
• Do not delay surgical intervention beyond 6 weeks for stones that fail conservative management 6
• Do not use opioids as first-line pain management when NSAIDs are appropriate 6, 7, 8