What drugs have been associated with or precipitate nephrolithiasis?
Several agents can crystallize in the urine, such as indinavir, topirmate, acyclovir, sulfadiazine, and triamterene. Stones related to these drugs usually involve the crystalline structure.
Topirmate is a carbonic anhydrase inhibitor and causes systemic metabolic acidosis, which leads to decreased urinary citrate excretion.
Alternation of urinary pH may increase the risk of calcium phosphate stones. Nephrolithiasis also has been reported with prolonged use of ceftriaxone in children.
Large amounts of vitamin C intake in men have been associated with an increased risk of calcium-based stone formation, presumably related to its metabolism to oxalate.
Initiation of uricosuric therapy with probenecid can precipitate uric acid stone formation. Loop diuretics (e.g., furosemide) can also play a role as a result of increased urinary calcium excretion and volume contraction related to diuresis. Conversely, thiazide-type diuretics reduce urinary calcium excretion.
