Prostaglandin Synthetase Inhibitors and their Effect on Urinary Calcium Excretion and other Parameters in Idiopathic Hypercalciuria

Abstract

The treatment of idiopathic hypercalciuric stone formers with the prostaglandin synthetase inhibitors flurbiprofen and indomethacin has been studied in two phases. Ten patients were studied in a metabolic unit for 14 days that included a control period of 7 days on a controlled intake of dietary calcium, followed by treatment with flurbiprofen 50 mg tds. Three patients were studied along similar lines and were treated with indomethacin 25 mg tds. A significant reduction in urinary calcium excretion was noted during the 7-day control period during which dietary calcium intake was reduced to 700 mg daily. No further significant reduction in urinary calcium excretion was observed during the treatment with either flurbiprofen or indomethacin. Thirteen patients then continued to take flurbiprofen 50 mg tds for between 1 and 12 months. A small but not statistically significant reduction in urinary calcium excretion was noted by the third month of treatment, but this was not sustained. This study confirms the benefit of dietary restriction of calcium as the primary approach to the treatment of idiopathic hypercalciuria. Neither flurbiprofen nor indomethacin reduced urinary calcium excretion to significant levels. Their routine use for the treatment of idiopathic hypercalciuria cannot be recommended from the evidence of this study.

Clinical Results in the Treatment of Therapy-Resistant Calcium-Stone Formers with Non-Steroidal Anti-Inflammatory Drugs

“…Glomerular filtration rates and urine excretion were reduced altogether. If hypercalciuria can be reduced by dietary means, no further decrease of calcium excretion can be attained by prostaglandin synthetase inhibitors [38], Colette et al [13] reported an increase in calcium excretion after indomethacine ad ministration in 7 healthy persons and concluded that the calcium-decreasing effect was only recognizable in idio pathic hypercalciuria patients.…”