Guaifenesin- and ephedrine-induced stones. J Endourol 1999 Nov;13(9):665-7
Date
12/23/1999Pubmed ID
10608519DOI
10.1089/end.1999.13.665Scopus ID
2-s2.0-0032801370 (requires institutional sign-in at Scopus site) 44 CitationsAbstract
PURPOSE: We report a new type of drug-induced stone that is caused by overconsumption of preparations containing guaifenesin and ephedrine.
MATERIALS AND METHODS: Clinical and stone analysis data from the Molecular Structure Laboratory at the Veterans Affairs Medical Center in Milwaukee, Wisconsin, were reviewed. Stone analysis was performed by Fourier transform infrared spectroscopy, high-resolution X-ray crystallographic powder diffraction, or both. The urine and stone material from one of the subjects were analyzed with high-performance liquid chromatography.
RESULTS: Stone analysis from seven patients demonstrated metabolites of guaifenesin. High-performance liquid chromatography revealed that the stone and urine from one subject had a high content of guaifenesin metabolites and a small amount of ephedrine. Demographic data were available on five patients. Three had a history of alcohol or drug dependency. All were consuming over-the-counter preparations containing ephedrine and guaifenesin. Four admitted to taking excessive quantities of these agents, mainly as a stimulant. Hypocitraturia was identified in two individuals subjected to urinary metabolic testing. These stones are radiolucent on standard X-ray imaging but can be demonstrated on unenhanced CT. Shockwave lithotripsy was performed in two patients, and the calculi fragmented easily.
CONCLUSIONS: Individuals consuming large quantities of preparations containing ephedrine and guaifenesin may be at risk to develop stones derived mainly from metabolites of guaifenesin and small quantities of ephedrine. These patients may be prone to drug or alcohol dependency.
Author List
Assimos DG, Langenstroer P, Leinbach RF, Mandel NS, Stern JM, Holmes RPAuthor
Peter Langenstroer MD Professor in the Urologic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultChromatography, High Pressure Liquid
Crystallography
Ephedrine
Female
Fourier Analysis
Guaifenesin
Humans
Kidney
Kidney Calculi
Male
Middle Aged
Nonprescription Drugs
Spectroscopy, Near-Infrared
Tomography
Tomography, X-Ray Computed
