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Disproportionality Analysis of Urinary Stone Formation With Carbonic Anhydrase Inhibitors: A VigiBase Analysis.
Jonathan J Song1, James McAndrew Jones2, David S Wang2
1Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
Urology Practice
|November 21, 2025
Summary
Carbonic anhydrase inhibitors (CAIs) are linked to a higher risk of urinary stones, especially in younger patients and those taking them for seizures. Higher doses increase this risk, necessitating patient counseling.
Area of Science:
- Pharmacovigilance
- Nephrology
- Drug Safety
Background:
- The use of carbonic anhydrase inhibitors (CAIs) is increasing, but their association with urinary stone formation is not well-studied.
- Urinary stones represent a significant adverse drug reaction (ADR) potentially linked to CAI use.
Purpose of the Study:
- To investigate the association between carbonic anhydrase inhibitors (CAIs) and stone-related adverse drug reactions (ADRs).
- To explore dose-dependent relationships and identify specific patient subgroups at higher risk for CAI-associated urinary stones.
Main Methods:
- A pharmacovigilance case-noncase study was conducted using VigiBase, a global database of adverse event reports.
- Disproportionality analysis, including reporting odds ratios (ROR) and 95% confidence intervals (CI), was used to assess the association between CAIs and stone formation.
Main Results:
- CAIs showed a significant association with stone-related ADRs (ROR 5.02).
- Topiramate, zonisamide, and acetazolamide were specifically linked to increased stone formation risk.
- Younger patients (<45 years) and those using CAIs for seizure indications exhibited higher risks, with dose-dependent associations observed for topiramate and zonisamide.
Conclusions:
- Carbonic anhydrase inhibitors are significantly associated with dose-dependent reporting of stone-related ADRs.
- Younger patients and those with seizure indications are at increased risk.
- Clinical counseling regarding the risk of urinary stone development is recommended for patients taking CAIs.
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