What is the recommended treatment and dosage for overactive bladder symptoms using Solifenacin?

From the Guidelines

Solifenacin is recommended at an initial dose of 5 mg once daily for overactive bladder symptoms, with the option to increase to 10 mg once daily if needed and tolerated, as supported by the most recent guideline amendment from 2019 1. The medication should be taken with water and can be administered with or without food. Patients should expect to see improvement in symptoms such as urgency, frequency, and urge incontinence within 1-2 weeks, though full effects may take up to 4 weeks. Some key points to consider when prescribing Solifenacin include:

• The combination of Solifenacin and Mirabegron has been shown to be effective in reducing symptoms of overactive bladder, with the Solifenacin/mirabegron 50 mg group being statistically significantly superior to both monotherapies at end of treatment for UUI episodes, urgency episodes, and nocturia 1.
• Common side effects of Solifenacin include dry mouth, constipation, and blurred vision, with adverse events being slightly increased in combination therapy groups compared to monotherapies 1.
• For elderly patients or those with severe renal impairment (creatinine clearance < 30 mL/min) or moderate hepatic impairment, the maximum recommended dose is 5 mg daily.
• Patients should be advised to maintain adequate hydration while avoiding excessive fluid intake, particularly before bedtime. If bothersome side effects occur or if symptoms don't improve after 4 weeks of treatment, patients should consult their healthcare provider for potential dose adjustment or alternative treatment options, as the efficacy and safety of Solifenacin have been established in several studies, including a clinical practice guideline from the American College of Physicians 1.

From the FDA Drug Label

The recommended oral dose of solifenacin succinate is 5 mg once daily. If the 5 mg dose is well tolerated, the dose may be increased to 10 mg once daily.

Do not exceed 5 mg once daily in patients with severe renal impairment (CLcr < 30 mL/min/1.73 m2)

Do not exceed 5 mg once daily in patients with moderate hepatic impairment (Child-Pugh B).

Do not use in patients with severe hepatic impairment (Child-Pugh C)

Do not exceed 5 mg once daily when solifenacin succinate is administered with strong CYP3A4 inhibitors such as ketoconazole

The recommended treatment and dosage for overactive bladder symptoms using Solifenacin is 5 mg once daily, which may be increased to 10 mg once daily if well tolerated. However, there are specific dosing recommendations for patients with:

• Severe renal impairment: do not exceed 5 mg once daily
• Moderate hepatic impairment: do not exceed 5 mg once daily
• Severe hepatic impairment: do not use
• Concomitant use of strong CYP3A4 inhibitors: do not exceed 5 mg once daily 2 2

From the Research

Recommended Treatment and Dosage for Overactive Bladder Symptoms using Solifenacin

• The recommended dose of Solifenacin for the treatment of overactive bladder (OAB) symptoms is 5mg once daily, which can be increased to 10mg once daily if the 5mg dose is well tolerated 3.
• Solifenacin has been shown to be efficacious in reducing OAB symptoms, including incontinence episodes, micturition frequency, and urgency episodes, with significant increases in volume voided 3, 4.
• The most common treatment-related adverse events associated with Solifenacin are expected anticholinergic side effects, such as dry mouth, constipation, and blurred vision, which are generally mild to moderate 3, 4.

Pharmacokinetics and Pharmacodynamics of Solifenacin

• Solifenacin has a high absolute bioavailability of about 90%, which does not decrease with concomitant food intake 5.
• The terminal elimination half-life of Solifenacin ranges from 33 to 85 hours, permitting once-daily administration 5.
• Solifenacin is eliminated mainly through hepatic metabolism via cytochrome P450 (CYP) 3A4, with about only 7% of the dose being excreted unchanged in the urine 5.

Efficacy of Solifenacin in Improving OAB Symptoms

• Solifenacin has been shown to be effective in improving OAB symptoms, including urgency, frequency, and incontinence, with significant improvements in health-related quality of life 4, 6.
• A flexible dosing strategy, with the option to increase the dose from 5mg to 10mg, can be effective in improving OAB symptoms with minimal impact on tolerability 7.
• Patients with more severe OAB symptoms may benefit from a higher dose of Solifenacin, with greater reductions in urgency episodes and improvements in other OAB symptoms observed with the 10mg dose compared to the 5mg dose 7.