Table 3.

When to use which medication.

Medication/dose	Indication
Potassium citrate/ 9–12 g/day Sodium bicarbonate 1.5 g 3×/day	When adjustment of the acid/base towards the alkaline region is needed and dietary measures are not sufficient. This can be the case for patients with high uric acid production, low dietary acid tolerance (overweight, renal acidification disorders), high intrinsic oxalate production. Stone types: uric acid, calcium-oxalates, ammonium urate
Hydrochlorothiazide 25–50 mg/day	To correct hypercalciuria when that cannot be corrected by dietary advice (or by surgery in the case of primary hyperparathyroidism) Stone types: calcium-salts
Magnesium salts 200–400 mg/day	For patients with oxalate overproduction (hyperoxaluria that cannot be corrected by dietary advice). Magnesium salts should not be given to patients with renal insufficiency Stone types: calcium oxalates
Pyridoxine 5–20 mg/kg/day	Patients in whom hyperoxaluria remains present despite dietary restriction of oxalate and normalisation of calcium intake (primary hyperoxaluria) Goal: normo-oxaluria
l-Methionine 200–500 mg 3× daily	When acidification of the urine is needed. This can be to remove fragments of infection stones (struvite/calcium apatites) or patients with uric acid/ammonium urate stones Goal: urinary pH 5.8–6.2, where urine pH remains >6.2 despite advice to neutralise the dietary acid/base intake
Allopurinol 100–300 mg/day	For patients with hyperuricosuria that is not corrected by dietary advice. These are patients who produce extra uric acid as a result of severe overweight or due to an enzymatic disorder. The high dose should be reserved for patients who have both hyperuricosuria and hyperuricosaemia