Studies have suggested that alpha blockers, such as tamsulosin (Flomax, Boehringer Ingelheim), can be helpful in treating ureterolithiasis by making it easier for stones to pass. However, there are no formal guidelines for using alpha blockade in the emergency department (ED).
Researchers from Advocate Christ Medical Center in Oak Lawn, Illinois, surveyed 103 emergency physicians in five states to find out how often they used Canadian Flomax. Sixty percent of respondents used it in fewer than 25% of patients with ureteral stones, and many had not heard of using generic Flomax for passage of urinary stones.
The most frequently reported factors associated with infrequent cheap Flomax use included the respondent’s uncertainty about formal recommendations for its use in urology, unfamiliarity with the drug’s use for this indication, questioning of the data supporting its use, not remembering to give the medication, and being unsure of contraindications.
Some physicians responded that proximal stones were unlikely to improve and that the cost outweighed the benefit; they also weren’t sure whether Flomax drug could be given to women.
Recent guidelines from the American Urological Association support the use of medical expulsive therapy, with alpha blockers being the currently preferred agents.
Source: Am JEmergMed2009;27:776-778