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Drug dosage protocol for calcium oxalate stone. | LitMetric

Drug dosage protocol for calcium oxalate stone.

Urol Res

Department of Surgery, Zensa Hospital, Trivandrum, 695009, India.

Published: December 2009

AI Article Synopsis

  • - The study investigates the effectiveness of allopurinol and pyridoxine in treating and preventing calcium oxalate urinary stones, involving 444 patients over 36 months with various dosage adjustments based on health parameters.
  • - Patients received different dosage regimens, categorized from very high to very low doses, and adjustments were made according to clinical evaluations during follow-up visits.
  • - Results showed that the majority of patients required lower doses than initially prescribed, with the most common adjustment being from very high-dose (3.5% of patients) to lower doses, emphasizing the need for personalized treatment plans in managing urinary stone disease.

Article Abstract

In earlier studies, we have confirmed that in most patients with calcium oxalate stone formation, a combination of allopurinol and pyridoxine is best suited for treatment and prevention of the stone forming process. The objective of this study is to identify the most effective directed medical treatment of urinary stones. The drug dose adjustment was based on clinical, radiological, biochemical, and microscopic parameters. 444 patients with proved calcium oxalate stone disease who were getting a combination of allopurinol and pyridoxine for a minimum period of 36 months were enrolled in this prospective study. The dosage schedule of these patients was recorded. Dosage adjustment was made depending upon the various clinical, biochemical, microscopic, and radiological changes during the study period. The dosage schedules were in six categories, namely very high dose chemotherapy (VHDC), i.e. allopurinol 600 mg/day and pyridoxine 240 mg/day, high-dose chemotherapy (HDC), i.e. allopurinol 300 mg/day and pyridoxine 120 mg/day, moderate dose prophylaxis (MDP), i.e. allopurinol 200 mg/day and pyridoxine 80 mg/day, low-dose prophylaxis (LDP), i.e. allopurinol 100 mg/day and pyridoxine 40 mg/day, and very low-dose prophylaxis (VLDP), i.e. allopurinol 50 mg/day and pyridoxine 20 mg/day and intermittent VLDP, wherein the VLDP was given on alternate months and still later at longer intervals. The temporary risk was assessed at each visit and dosage adjustment was made. The effect of the intervention was assessed during the next visit. All the patients involved in the study needed dose adjustment. The following schedules were initiated: VHDC (12) 3.5%, HDC (103) 23.2%, MDP (78) 17.57%, or LDP (251) 56.53%. Patients who defaulted for more than a month were excluded from the study. During each visit for follow up, all patients were advised change over of dose depending upon the clinical situation at the time of review. Patients on VHDC were advised reduction to lower doses systematically. On passage of stones, the dose was immediately reduced to LDP in all situations unless prevented by the presence of significant crystalluria or severe pain. All patients on MDP had reduction of dose to LDP subsequently. Patients started on LDP needed elevation in dose in 63 (16.8%) to HDC and 23 patients (12.87%) to MDP. Dose of 247 patients could be reduced to VLDP (55.63%) and later on to intermittent VLDP 85 (19.14%). 74 (16.7%) patients continued to be on LDP throughout the period of study. It is concluded that in managing the stone patient, the clinical, radiological, microscopic and biochemical parameters should be taken into consideration in deciding the reduction/increase in the dose of drugs. The principle of giving chemotherapy/chemoprophylaxis should be to administer the least number of drugs in the least dosage depending upon the requirement of the disease.

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Source
http://dx.doi.org/10.1007/s00240-009-0222-4DOI Listing

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