What is Vesicare Used For?
Vesicare (solifenacin) is a muscarinic antagonist medication used to treat overactive bladder in adults with symptoms of urge urinary incontinence, urgency, and urinary frequency. 1
Primary Indication
Solifenacin is FDA-approved specifically for treating adults with overactive bladder syndrome who experience: 1
- Urge urinary incontinence: involuntary leaking or wetting accidents accompanied by a strong, sudden need to urinate 1
- Urgency: a strong, immediate need to urinate that is difficult to defer 1
- Urinary frequency: urinating too often throughout the day 1
Position in Treatment Algorithm
Solifenacin is recommended as second-line therapy for overactive bladder, to be initiated only after behavioral therapies have been tried. 2 The American Urological Association guidelines establish that behavioral interventions—including bladder training, delayed voiding, pelvic floor muscle training, fluid management, and weight loss—should be attempted first. 3
Clinical Efficacy
Solifenacin demonstrates effectiveness across all overactive bladder symptoms: 2
- Reduces urinary incontinence episodes 2
- Decreases urgency episodes 2
- Reduces urinary frequency 2
- Improves nocturia (nighttime urination) 2
The medication shows dose-response effects, with both 5 mg and 10 mg doses demonstrating symptom improvement compared to placebo, though the absolute benefit is modest (less than 20% absolute risk difference). 4
Combination Therapy Options
For patients with inadequate response to monotherapy, solifenacin can be combined with: 5, 2
- Mirabegron 50 mg: The combination of solifenacin 5 mg plus mirabegron 50 mg demonstrates superior efficacy to either medication alone in reducing incontinence episodes and urination frequency, per European Association of Urology guidelines 2
- Tamsulosin: For men with both storage and voiding lower urinary tract symptoms 5
- β3-adrenoceptor agonists: For patients refractory to monotherapy 5
Important Safety Considerations
Solifenacin is contraindicated in patients who: 1
- Cannot empty their bladder (urinary retention) 1
- Have delayed or slow gastric emptying (gastric retention) 1
- Have uncontrolled narrow-angle glaucoma 1
- Are allergic to solifenacin or its ingredients 1
Use with extreme caution in patients with: 2
Common Adverse Effects
The most frequently reported side effects include: 1
- Dry mouth (21.4% of patients) 6
- Constipation (13.3% of patients) 6
- Blurred vision 1
- Urinary tract infection 1
These anticholinergic effects are generally mild to moderate in severity, though approximately 10% of patients discontinue treatment due to adverse events. 6
Age Considerations
Solifenacin is equally well tolerated in younger (≤65 years) and older (>65 years) patients, with similar incidence and severity of adverse effects across age groups. 7 However, beta-3 agonists like vibegron may be preferable for elderly patients due to lower risk of cognitive impairment or dementia compared to antimuscarinic medications. 3