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Calcium Channel Blockers as an Emergency Treatment for Renal Colic

Three Part Question

In [patients presenting with renal colic] are [calcium channel blockers] a [useful emergency department treatment]?

Clinical Scenario

A 42 year old man attends the Emergency Department with an episode of renal colic. PR voltarol has not provided any relief. You wonder if a calcium channel blocker would facilitate passage of the stone and allow for earlier discharge from the Emergency Department.

Search Strategy

Medline 1966 - 08 using the OVID interface
[Ureteral Calculi/ or renal or Kidney Calculi] AND [calcium channel or Calcium Channel Blockers]
Limit to human and English

Search Outcome

12 papers were found of which 5 were relevant
Search of references revealed another 2 papers

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Singh, Harrison, Littlepage
Pooled analysis of 16 studies using alpha antagonist and 9 studies using calcium channel blockerMeta-analysis Included non-English studiesStone expulsion rates, time to expulsion of stoneMedical therapy using calcium channel blockers significantly increases stone expulsion rate. NNT was 3.9. Time to expulsion was significantly reduced - range 2-14 days
Hollingsworth, Rogers
Pooled data from 9 trialsMeta-analysisStone expulsion ratesPatients given calcium channel blockers or alpha blockers had a 65% greater likelihood of stone passage than if given no treatment. NNT was 43 studies gave multiple drugs to their treatment group making analysis difficult
Davenport, Timoney
210 strips of human ureterProspective trialRelaxant effect on ureterNifedipine produced greater ureteric relaxation in vitro than diclofenacRelevant to question?
Dellabella, Milanese
210 symptomatic patients with distal ureteral calculi. Randomly allocated to receive phloroglucinol, tamsulosin or nifedipine (70 in each group)Randomised prospective trialStone expulsion rates, time to expulsion of stoneExpulsion rate significantly higher with tamsulosin (97%) than phloroglucinol (64.3%) or nifedipine (77.1%)Not blinded No control group
Porpiglia, Destefanis, Fiori
96 patients with radiopaque stones of <1cm in the distal ureter. Randomly divided into 2 groups. Group A (n=48) given deflazacort + nifedipine. Group B no drugsRandomised controlled trialStone expulsion rates, time to expulsion of stoneStatistically significant increased stone expulsion rate and time in treatment group (79% and 7 days for treatment compared to 35% and 20 days for control)Initial patient selection not randomised. Treatment group given both deflazacort and nifedipine
Cooper, Stack, Cooper
70 consecutive patients with renal calculi. 35 randomised to control given ketorolac, oxycodone and acetaminophen combination tablets. Treatment group given the above + nifedipine, prednisolone, trimethoprim/sulfa and acetaminophenRandomised controlled trialStone expulsion rates, time to expulsion of stone, work days lost, visits to Emergency DepartmentTreatment arm had significantly higher stone passage rates (86% vs 56%) + lost fewer work days. ED visits reduced from 4 in control arm to 1 in treatment armNo blinding. Treatment arm received 4 extra medications compared to control, therefore unable to ascertain which drug was having beneficial effect
Porpiglia, Ghignone, Fiori, Fontana, Scarpa
86 patients with stones <1cm in lower ureter. Randomly divided into 3 groups. Gp 1 received deflazacort and nifedipine, gp 2 deflazacort and tamsulosin, gp 3 control (no drugs)Randomised controlled trialStone expulsion rates, time to expulsion of stoneGroups 1 and 2 significantly increased expulsion rate compared to control. No significant difference between groups 1 and 2Initial selection not randomised. No blinding. Why were group 3 not given deflazacort - makes results difficult to interpret


The calcium channel blocker most frequently used was nifedipine 30mg/day. The above studies and 2 meta-analyses all showed a benefit in increasing stone passage rates when medical therapy with a calcium channel blocker or alpha blocker was used. Time to expulsion of stone was also significantly reduced, however, even with medical therapy this ranged from 2 to 14 days. In an Emergency Department setting calcium channel blockers are unlikely to change management i.e. whether a patient needs to be admitted while a stone is passed, however starting medical therapy prior to discharge in a patient who has urology follow up may be a consideration.

Clinical Bottom Line

Calcium channel blockers enhance stone passage over days rather than hours, therefore are not a definitive Emergency Department treatment


  1. Singh A. Alter HJ. Littlepage A A systematic review of medical therapy to facilitate passage of ureteral calculi Annals of Emergency Medicine 50(5):552-63, 2007 Nov
  2. Hollingsworth JM, Rogers MAM, Kaufman SR Medical therapy to facilitate urinary stone passage: a meta-analysis Lancet 368: 1171-79
  3. Davenport K. Timoney AG. Keeley FX A comparative in vitro study to determine the beneficial effect of calcium-channel and alpha 1-adrenoceptor antagonism on human ureteric activity BJU International 98(3):651-5, 2006 Sep
  4. Dellabella M. Milanese G. Randomised trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi Journal of Urology 174(1):167-72, 2005 Jul
  5. Porpiglia F. Destefanis P. Fiori C. Fontana D. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones Urology 56(4):579-82, 2000 Oct 1
  6. Cooper JT. Stack GM. Cooper TP Intensive medical management of ureteral calculi Urology 56(4):575-8, 2000 Oct 1
  7. Porpiglia F. Ghignone G. Fiori C. Nifedipine versus tamsulosin for the management of lower ureteral stones Journal of Urology Vol. 172, 568-571, Aug 2004