Synopsis
Select a stable patient for an informed trial of medical expulsive therapy, prescribe the chosen formulation safely and stop treatment when passage, intolerance or an intervention indication changes the plan.
- Medical expulsive therapy is an optional aid to passage in a selected stable patient; infection, refractory pain or deteriorating renal function require reassessment and can make active treatment necessary.
- NICE considers alpha blockers for distal ureteric stones below 10 mm. EAU 2026 offers them as an option for distal stones 5–10 mm, with the greatest expected benefit in stones above 5 mm; explain the source-specific boundary.
- Tamsulosin for stone passage is off-label. A studied adult regimen is 400 micrograms orally daily for up to 28 days, with earlier review and cessation for passage, complications or adverse effects;28 days is not a compulsory guideline course.
Investigation priorities
Check that the stone fits the evidence population and identify obstruction.
Management branches
A fifty two year old man has a seven-millimetre distal ureteric stone, controlled pain and creatinine at baseline.
- He is afebrile, can drink and has no solitary kidney, bilateral obstruction or current reason for urgent stone removal. Medicines reconciliation finds no interacting alpha blocker or strong CYP3A4 inhibitor; there is no orthostatic history, severe liver disease or planned eye operation. The clinician explains the NICE and EAU populations, the greater potential benefit for this stone size and the off-label nature of treatment.
- He chooses a monitored trial and starts the selected tamsulosin 400 microgram prolonged-release capsule orally once daily after breakfast, swallowed whole. The prescription has a maximum planned duration of 28 days, using the studied adult regimen, with an earlier review and instructions to stop and seek assessment for infection, renal deterioration, refractory pain or important adverse effects. This maximum does not oblige him to continue after passage.
Key medicines
Tamsulosin 400 microgram prolonged-release capsules, selected Zentiva productFor a selected stable adult with a distal ureteric stone, off-label 400 micrograms orally once daily after breakfast or the first meal; swallow whole. A studied regimen lasts up to 28 days, with individual earlier review and stop on confirmed passage, a complication or intolerance. Do not crush or chew, increase the dose to force passage or treat 28 days as a compulsory course.Contraindicated with a history of orthostatic hypotension, severe hepatic insufficiency or hypersensitivity including drug-induced angioedema. Renal impairment needs no routine dose adjustment, but CrCl below 10 mL/min was not studied: use specialist caution. Mild or moderate hepatic impairment needs no adjustment. Check postural symptoms and interacting medicines; other alpha blockers increase hypotension. Do not combine strong CYP3A4 inhibitors with tamsulosin in a CYP2D6 poor metaboliser, and use caution with strong or moderate CYP3A4 inhibitors generally. Initiation before scheduled cataract or glaucoma surgery is not recommended; tell the eye surgeon about current or past use. Sit or lie down for dizziness or weakness and obtain assessment; stop immediately for angioedema and do not readminister. The selected licence is BPH, not stone passage; do not extrapolate this adult regimen to pregnancy or children.