Is solifenacin (generic name) effective for treating frequent voiding symptoms in patients with overactive bladder (OAB)?

Solifenacin for Frequent Voiding Symptoms

Solifenacin is effective for treating frequent voiding symptoms in patients with overactive bladder (OAB), with the FDA-approved indication specifically for adults with OAB symptoms including urge urinary incontinence, urgency, and urinary frequency. 1

Efficacy for Frequent Voiding Symptoms

Solifenacin has demonstrated significant efficacy in treating frequent voiding symptoms:

• Clinical trials show that solifenacin 5 mg once daily significantly reduces micturition frequency by 2.3 episodes per 24 hours compared to 1.4 with placebo (p<0.001) 1
• Solifenacin 10 mg once daily provides even greater reduction in micturition frequency (2.7 episodes per 24 hours) 1
• In addition to reducing frequency, solifenacin significantly improves other OAB symptoms:
  • Reduces incontinence episodes (1.5 fewer episodes with 5 mg vs 1.1 with placebo, p<0.001) 1
  • Increases volume voided per micturition (32.3 mL increase with 5 mg vs 8.5 mL with placebo, p<0.001) 1
  • Reduces urgency episodes 2

Dosing and Administration

• The recommended starting dose is 5 mg once daily 3
• Can be increased to 10 mg once daily if 5 mg is well tolerated and greater symptom relief is needed 3
• Approximately 53% of incontinent patients achieve complete continence with solifenacin treatment 2

Safety and Tolerability

Solifenacin is generally well-tolerated, but patients should be monitored for:

• Common anticholinergic side effects:

  • Dry mouth (10.9% with 5 mg, 27.1% with 10 mg) 4
  • Constipation (5.3% with 5 mg, 12.9% with 10 mg) 4
  • Blurred vision (4.5% with 5 mg, 4.7% with 10 mg) 4

• Most adverse events are mild to moderate in intensity 2

• Discontinuation rates due to adverse events are comparable to placebo 3

Special Considerations

• For patients with narrow-angle glaucoma, antimuscarinic agents like solifenacin should be avoided unless approved by an ophthalmologist 5
• Use with caution in patients with impaired gastric emptying or history of urinary retention 5
• In men with benign prostatic hyperplasia (BPH) and overactive bladder symptoms, combination therapy with solifenacin and an alpha-blocker (such as tamsulosin) has shown efficacy and safety 6
• The NEPTUNE trial demonstrated that combination therapy with solifenacin and tamsulosin was effective for lower urinary tract symptoms in men 6

Treatment Algorithm

1. First-line approach: Begin with solifenacin 5 mg once daily for patients with OAB symptoms including frequent voiding
2. Assessment: Evaluate response after 4-8 weeks of treatment
3. Dose adjustment: If 5 mg is well tolerated but symptom relief is inadequate, increase to 10 mg once daily
4. For men with BPH and OAB symptoms: Consider combination therapy with an alpha-blocker (e.g., tamsulosin) and solifenacin
5. Monitoring: Regular follow-up to assess symptom improvement and potential side effects

Quality of Life Impact

Treatment with solifenacin has been shown to significantly improve health-related quality of life in patients with OAB 7, which is an important consideration given the distressing nature of frequent voiding symptoms.