What is Vesicare (Solifenacin)?

What is Vesicare (Solifenacin)?

Vesicare (solifenacin succinate) is a muscarinic receptor antagonist (antimuscarinic) medication prescribed for adults with overactive bladder to treat urge urinary incontinence, urgency, and urinary frequency. 1

Mechanism of Action

• Solifenacin works by blocking muscarinic receptors in the bladder, which reduces involuntary bladder contractions and increases bladder storage capacity. 1
• The medication is chemically formulated as solifenacin succinate and is available in 5 mg and 10 mg oral tablets. 1

Clinical Indications

Solifenacin is indicated as second-line therapy for overactive bladder after behavioral therapies have been attempted. 2

• It effectively treats all core symptoms of overactive bladder including:
  • Reduction in urinary incontinence episodes 2
  • Decrease in urgency episodes 2
  • Reduction in urinary frequency 2
  • Improvement in nocturia 2

Dosing and Administration

• Start with solifenacin 5 mg once daily, taken with water and swallowed whole, with or without food. 1
• The dose may be increased to 10 mg once daily based on individual response and tolerability. 2
• If a dose is missed, resume the next day—never take two doses on the same day. 1

Combination Therapy Options

• For men with both storage and voiding lower urinary tract symptoms, solifenacin can be combined with tamsulosin (an alpha-blocker). 3
• The combination of solifenacin 5 mg plus mirabegron 50 mg demonstrates superior efficacy compared to either medication alone for reducing incontinence episodes and micturitions. 2
• Solifenacin may be combined with β3-adrenoceptor agonists for patients who do not respond adequately to monotherapy. 3

Important Safety Warnings and Contraindications

Do not use solifenacin if you have: 1

• Urinary retention (inability to empty bladder)
• Gastric retention (delayed or slow stomach emptying)
• Uncontrolled narrow-angle glaucoma
• Known allergy to solifenacin or its ingredients

Use with extreme caution in patients with: 2

• Impaired gastric emptying
• History of urinary retention
• Narrow-angle glaucoma
• Bladder outlet obstruction
• Decreased gastrointestinal motility

Common Side Effects

The most frequently reported adverse effects include: 1

• Dry mouth (21.4% of patients) 4
• Constipation (13.3% of patients) 4
• Urinary tract infection 1
• Blurred vision 1
• Headache (3.4% of patients) 4

Serious Adverse Effects to Monitor

• Angioedema: Discontinue immediately if you experience tongue or throat swelling or difficulty breathing. 1
• Urinary retention: May worsen in patients with bladder outlet obstruction. 1
• Severe constipation: Contact your healthcare provider if constipation persists for 3 or more days or if severe abdominal pain develops. 1
• Central nervous system effects: Exercise caution with driving or operating machinery until you know how the medication affects you. 1
• Heat prostration: Decreased sweating can occur, leading to heat exhaustion in hot environments. 1

Special Populations

• Older adults (≥65 years): Solifenacin demonstrates similar efficacy and tolerability in older versus younger patients, with comparable adverse event rates. 5
• Pregnancy and breastfeeding: It is unknown if solifenacin harms unborn babies or passes into breast milk; discuss with your healthcare provider before use. 1
• Patients with liver or kidney problems: Inform your healthcare provider, as dose adjustments may be necessary. 1

Patient-Reported Outcomes

• Patients treated with flexibly-dosed solifenacin report significant improvements in bladder condition perception, with mean Patient Perception of Bladder Condition (PPBC) scores improving from 4.4 (moderate-to-severe problems) to 2.9 (minor problems). 4
• Health-related quality of life measures show significant improvements across all domains including coping, concern, sleep, and social functioning. 4
• Approximately 80% of patients achieve meaningful improvement in their perception of bladder condition. 6