Is solifenacin an anticholinergic medication?

Solifenacin is an Anticholinergic Medication

Yes, solifenacin is definitively an anticholinergic medication that acts as a competitive muscarinic receptor antagonist, primarily targeting M3 receptors in the bladder to treat overactive bladder syndrome. 1

Mechanism of Action and Classification

Solifenacin functions as a selective antimuscarinic agent with the following characteristics:

• Acts as a competitive antagonist at muscarinic receptors, particularly M3 receptors that mediate bladder contractions 1
• Blocks acetylcholine binding to muscarinic receptors in the detrusor muscle, reducing bladder smooth muscle contractions 2
• Has higher selectivity for bladder tissue compared to salivary glands than some other anticholinergic medications 3
• Classified pharmacologically as a muscarinic receptor antagonist in all major guidelines 4

Anticholinergic Properties and Effects

Solifenacin demonstrates classic anticholinergic effects:

• Common anticholinergic side effects include:

  • Dry mouth (most common, occurring in 26.8% of patients at 10mg dose) 5
  • Constipation (17.1% at 10mg dose) 5
  • Blurred vision (3.5% at 10mg dose) 5
  • Cognitive effects (particularly in elderly patients) 4

• The European Association of Urology guidelines specifically refer to solifenacin as an "anticholinergic medication" when discussing combination therapy with alpha-blockers 4

• The American Urological Association guidelines classify solifenacin among "oral anti-muscarinics" as second-line therapy for overactive bladder 4

Clinical Implications of Anticholinergic Status

The anticholinergic nature of solifenacin has important clinical implications:

• Contraindications: Should not be used in patients with:

  • Urinary retention
  • Gastric retention
  • Uncontrolled narrow-angle glaucoma 1

• Cautions in specific populations:

  • Elderly patients are at higher risk for anticholinergic side effects 4
  • Patients taking multiple medications (≥7) experience more adverse effects 4
  • Contributes to "anticholinergic burden" when combined with other anticholinergic medications 4

• Dosing considerations:

  • Maximum recommended dose is 5mg daily in patients with severe renal impairment or moderate hepatic impairment 1
  • Not recommended in patients with severe hepatic impairment 1

Anticholinergic Risk in Elderly Patients

The Mayo Clinic Proceedings specifically identifies solifenacin among "strongly anticholinergic medications" used for overactive bladder that can negatively impact elderly patients 4:

• Contributes to anticholinergic burden that can adversely affect cognition and functionality
• Can cause decline in cognition, functional status, and activities of daily living scores
• May increase risk of falls, confusion, delirium, emergency department visits, and hospitalizations 4

In conclusion, solifenacin is unequivocally classified as an anticholinergic medication in medical literature and clinical practice guidelines, with a mechanism of action and side effect profile consistent with this classification.