What is the use of Solifenacin (VESIcare)?

From the Guidelines

Solifenacin is recommended as a first-line treatment for overactive bladder symptoms, including urinary frequency, urgency, and incontinence, due to its efficacy and relatively low risk of discontinuation due to adverse effects, as shown in the 2019 AUA/SUFU guideline amendment 1. The standard starting dose of solifenacin is 5 mg once daily, which can be increased to 10 mg daily if needed and tolerated. Solifenacin works by blocking muscarinic receptors in the bladder, which reduces involuntary bladder muscle contractions and increases bladder capacity. This medication should be taken with water, with or without food, at approximately the same time each day. Some key points to consider when prescribing solifenacin include:

• Patients typically notice improvement in symptoms within 1-2 weeks, though full effects may take up to 4 weeks.
• Common side effects include dry mouth, constipation, and blurred vision due to its anticholinergic properties.
• Solifenacin should be used with caution in patients with narrow-angle glaucoma, significant bladder outflow obstruction, or severe liver disease.
• Patients should maintain adequate hydration while taking this medication but may want to limit fluid intake before bedtime to reduce nighttime urination.
• If side effects become bothersome, patients should consult their healthcare provider rather than discontinuing the medication abruptly. According to the American College of Physicians guideline on nonsurgical management of urinary incontinence in women, solifenacin has a moderate magnitude of benefit in achieving continence rates but is associated with adverse effects, with a number needed to harm (NNH) of 6 (CI, 4 to 12) 1. Additionally, the SYNERGY II trial showed that combination therapy with solifenacin and mirabegron was statistically superior to monotherapy with either agent for decreasing the number of incontinence episodes and micturitions per 24 hours 1. Overall, solifenacin is a viable treatment option for patients with overactive bladder symptoms, and its use should be tailored to individual patient needs and medical history.

From the FDA Drug Label

Solifenacin succinate tablets are indicated for the treatment of adults with overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. Solifenacin succinate tablets are a muscarinic antagonist indicated for the treatment of adults with overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. Solifenacin succinate tablets are a prescription medicine for adults used to treat the following symptoms due to a condition called overactive bladder : Urge urinary incontinence: a strong need to urinate with leaking or wetting accidents Urgency: a strong need to urinate right away Frequency: urinating often

Solifenacin is used to treat overactive bladder symptoms, including:

• Urge urinary incontinence
• Urgency
• Urinary frequency 2, 2, 2

From the Research

Solifenacin Overview

• Solifenacin is a bladder-selective, muscarinic (M1 and M3) receptor antagonist used to treat overactive bladder syndrome (OAB) 3.
• It works by reducing the contractility of the detrusor muscle, thereby decreasing urinary urgency, frequency, and incontinence 4, 5.

Efficacy of Solifenacin

• Solifenacin has been shown to be effective in reducing symptoms of OAB, including urinary urgency, frequency, and incontinence, in several clinical trials 6, 3, 4.
• In Phase 3 studies, solifenacin 5 mg and 10 mg once daily improved symptoms of OAB and increased functional bladder capacity to a significantly greater extent than placebo 3, 4.
• Solifenacin 5 mg and 10 mg were also found to be non-inferior to tolterodine extended release 4 mg daily for improving urinary frequency, and had significantly greater efficacy for improving other symptoms of OAB 3.

Safety and Tolerability of Solifenacin

• Solifenacin is generally well tolerated, with the most common adverse events being dry mouth, constipation, and blurred vision 6, 3, 4.
• The incidence of these adverse events is dose-dependent, with higher doses of solifenacin associated with a greater incidence of adverse events 4.
• Combination therapy with solifenacin and mirabegron has been shown to be well tolerated, with no important additional safety findings compared to monotherapy or placebo 7.

Combination Therapy with Solifenacin

• Combination therapy with solifenacin and mirabegron has been shown to significantly improve symptoms of OAB, including mean volume voided per micturition, micturition frequency, and urgency episodes, compared to solifenacin 5 mg monotherapy 7.
• The combination of solifenacin and mirabegron may offer a therapeutic advantage over solifenacin monotherapy, with improved efficacy and similar safety and tolerability 7.