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

Solifenacin Treatment for Overactive Bladder

The recommended treatment for overactive bladder using solifenacin is to start with 5 mg once daily, which may be increased to 10 mg once daily if the initial dose is well tolerated and greater symptom relief is needed. 1

Dosage Recommendations

• Solifenacin succinate tablets should be taken with water and swallowed whole, with or without food 1
• Initial dosage is 5 mg once daily, which can be increased to 10 mg once daily if well tolerated 1
• Dose adjustments are required in special populations:
  • Do not exceed 5 mg once daily in patients with severe renal impairment (CLcr < 30 mL/min/1.73 m²) 1
  • Do not exceed 5 mg once daily in patients with moderate hepatic impairment (Child-Pugh B) 1
  • Do not use in patients with severe hepatic impairment (Child-Pugh C) 1
  • Do not exceed 5 mg once daily when administered with strong CYP3A4 inhibitors such as ketoconazole 1

Efficacy

• Solifenacin demonstrates efficacy for all symptoms of overactive bladder, including: 2, 3
  • Reduction in urinary incontinence episodes
  • Decrease in urgency episodes
  • Reduction in urinary frequency
  • Improvement in nocturia
• Greater than half of patients who were incontinent at baseline no longer reported experiencing incontinence episodes after 12 weeks of treatment with solifenacin 5 mg 4
• Improvements in symptoms are observed as early as week 2 of treatment and are maintained over 12-week and 1-year time periods 3
• Patients with severe OAB symptoms show objective and subjective improvements in symptoms, symptom bother, health-related quality of life, and urgency severity with solifenacin 5

Combination Therapy Options

• The combination of solifenacin 5 mg plus mirabegron 50 mg has demonstrated superior efficacy compared to either medication alone in reducing incontinence episodes and micturitions 2, 6
• This combination therapy has shown additive effects for decreasing urgency urinary incontinence episodes, urgency episodes, and nocturia 6
• Solifenacin can be used in combination with tamsulosin for men with both storage and voiding lower urinary tract symptoms 7

Dose Escalation Considerations

• Patients with more severe OAB symptoms at baseline may benefit from dose escalation from 5 mg to 10 mg 8
• In clinical studies, patients who requested a dose increase after 8 weeks of treatment with 5 mg generally had more severe OAB symptoms at baseline 8
• Increasing the dose to 10 mg provided further improvement in OAB symptoms for these patients, with statistically significant reductions in total urgency score, maximum urgency rating, and micturition frequency 8

Safety and Adverse Effects

• The most common adverse reactions (>4% and greater than placebo) are: 1
  • Dry mouth and constipation at both 5 mg and 10 mg doses
  • Urinary tract infection and blurred vision at the 10 mg dose
• Solifenacin is contraindicated in patients with: 1
  • Urinary retention
  • Gastric retention
  • Uncontrolled narrow-angle glaucoma
  • Hypersensitivity to solifenacin or its components
• Use with caution in patients with controlled narrow-angle glaucoma 1
• Not recommended for use in patients at high risk of QT prolongation 1

Monitoring and Follow-up

• Evaluate treatment response after 4-8 weeks to determine if dose adjustment is needed 8
• Patients who show inadequate response to 5 mg after 8 weeks may benefit from dose escalation to 10 mg 8
• Monitor for adverse effects, particularly anticholinergic side effects such as dry mouth, constipation, and blurred vision 4, 3