From the Guidelines
Solifenacin is contraindicated in patients with urinary retention, gastric retention, uncontrolled narrow-angle glaucoma, or hypersensitivity to the medication, as well as those with severe hepatic impairment (Child-Pugh C) and severe renal impairment or moderate hepatic impairment who are taking strong CYP3A4 inhibitors like ketoconazole. According to the 2019 AUA/SUFU guideline amendment 1, solifenacin should be used with caution in patients with certain conditions due to its anticholinergic effects. These conditions include bladder outflow obstruction, gastrointestinal obstructive disorders, decreased gastrointestinal motility, controlled narrow-angle glaucoma, reduced renal or hepatic function, and myasthenia gravis. The medication works by blocking muscarinic receptors, particularly M3 receptors, which reduces involuntary bladder contractions and increases bladder capacity. This mechanism explains why it can worsen conditions like glaucoma or urinary retention.
Some key points to consider when prescribing solifenacin include:
- Monitoring patients for anticholinergic side effects, including dry mouth, constipation, blurred vision, and heat intolerance 1
- Using caution in elderly patients who may be more sensitive to these effects
- Avoiding use in patients with severe hepatic impairment (Child-Pugh C) or severe renal impairment, especially when taking strong CYP3A4 inhibitors like ketoconazole
- Being aware of the potential for increased adverse events, including dry mouth, constipation, and dyspepsia, when used in combination with other medications like mirabegron 1
Overall, solifenacin can be an effective treatment for overactive bladder, but its use requires careful consideration of the patient's medical history and current medications to minimize the risk of adverse effects.
From the FDA Drug Label
Solifenacin succinate is contraindicated in patients: • With urinary retention [see Warnings and Precautions (5.2)], • With gastric retention [see Warnings and Precautions (5.3)], • With uncontrolled narrow-angle glaucoma [see Warnings and Precautions (5.5)], and • Who have demonstrated hypersensitivity to solifenacin succinate or the inactive ingradients in solifenacin succinate. Reported adverse reactions have included anaphylaxis and angioedema [see Adverse Reactions (6.2)].
The contraindications for solifenacin are:
- Urinary retention
- Gastric retention
- Uncontrolled narrow-angle glaucoma
- Hypersensitivity to solifenacin succinate or its inactive ingredients 2.
From the Research
Solifenacin Contraindications
- The provided study 3 does not explicitly mention contraindications for Solifenacin.
- However, it discusses the pharmacologic properties and effects of Solifenacin, indicating its use for treating overactive bladder.
- The study highlights Solifenacin's selectivity for the bladder over the salivary gland, which may imply a lower risk of certain side effects, but does not provide information on contraindications.
- There is no direct information available from the given evidence to list specific contraindications for Solifenacin.