solifenacin

Acts as a muscarinic (cholinergic) receptor antagonist; antagonizes bladder smooth muscle contraction.

Therapeutic effects:

Decreased symptoms of overactive bladder.
Improved maximum cystometric capacity in neurogenic detrusor overactivity.

Pharmacokinetics ⬆ ⬇

Absorption: 90% absorbed following oral administration.

Distribution: Extensively distributed to tissues.

Protein Binding: 98%.

Metabolism/Excretion: Extensively metabolized by liver via the CYP3A4 isoenzyme. 69% excreted in urine as metabolites, 22% in feces.

Half-Life: Tablets: 45–68 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
Oral	unknown	3–8 hr	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Urinary retention;
Gastric retention;
Uncontrolled angle-closure glaucoma;
Severe hepatic impairment;
History of QT interval prolongation.

Use Cautiously in:

Moderate hepatic impairment (lower dose recommended);
Renal impairment;
Bladder outflow obstruction;
GI obstructive disorders, severe constipation, or ulcerative colitis;
Myasthenia gravis;
Angle-closure glaucoma;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: palpitations, QT interval prolongation, tachycardia

EENT: blurred vision

GI: constipation, dry mouth, abdominal pain, dyspepsia, nausea

GU: urinary tract infection

MS: muscle weakness

Neuro: confusion, drowsiness, hallucinations, headache

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

Strong CYP3A4 inhibitors, including ketoconazole, may significantly ↑ levels and risk of toxicity.
QT interval prolonging medications may ↑ risk of QT interval prolongation; avoid concurrent use.

Route/Dosage ⬆ ⬇

Overactive Bladder

PO (Adults ): Tablets: 5 mg once daily; may ↑ to 10 mg once daily; Concurrent use of strong CYP3A4 inhibitors: Tablets: Not to exceed 5 mg once daily.

Renal Impairment

PO (Adults ): CCr <30 mL/min: Tablets: Not to exceed 5 mg once daily.

Hepatic Impairment

PO (Adults ): Moderate hepatic impairment: Tablets: Not to exceed 5 mg once daily.

Availability ⬆ ⬇

(Generic available)

Tablets (Vesicare): 5 mg; 10 mg

Assessment ⬆ ⬇

Monitor for signs/symptoms of hypersensitivity reaction (angioedema, anaphylaxis) after 1st and subsequent doses; may occur up to several hours afterward. If swelling of the upper tongue, hypopharynx, or larynx occurs, promptly discontinue solifenacin and provide therapy as indicated.
Overactive Bladder: Monitor voiding pattern and assess symptoms of overactive bladder (urinary urgency, incontinence, frequency) before starting and periodically during therapy.

Implementation ⬆ ⬇

PO: Administer once daily without regard to food. DNC: Tablets must be swallowed whole; do not break, crush, or chew.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Overactive bladder: if dose missed, omit and take next day; do not take 2 doses in same day.
May cause dizziness and blurred vision. Caution patient to avoid driving and other activities that require alertness until response to medication is known.
Advise patient to discontinue solifenacin and notify health care provider immediately if hives; rash; swelling of lips, face, tongue, or throat; or trouble breathing occurs.
Inform patient of potential anticholinergic side effects (constipation, urinary retention, blurred vision, heat prostration in a hot environment) and to notify health care provider if symptoms persist.
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care provider before taking any new medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇