What is the starting dose of solifenacin (generic name) for an adult patient with overactive bladder symptoms and normal renal function?

Starting Dose of Solifenacin

The starting dose of solifenacin for adults with overactive bladder and normal renal function is 5 mg taken orally once daily. 1

Dosing Regimen

• Begin with 5 mg once daily, which can be increased to 10 mg once daily if the initial dose is well tolerated and additional symptom control is needed 1
• The 5 mg starting dose is effective for reducing all key OAB symptoms including urgency, incontinence episodes, micturition frequency, and nocturia, with over half of incontinent patients achieving continence after 12 weeks of treatment 2
• Efficacy is typically observed as early as week 2 of treatment and is maintained over 12-week and 1-year periods 3

When to Consider Dose Escalation

• Patients with more severe baseline OAB symptoms who have inadequate response after 8 weeks on 5 mg benefit from dose escalation to 10 mg 4
• Increasing to 10 mg provides statistically significant additional reductions in total urgency score, maximum urgency rating, and micturition frequency compared to remaining on 5 mg 4
• The dose increase to 10 mg is well tolerated, with only 5.7% of patients reporting new or worsening dry mouth 4

Dose Modifications for Special Populations

• Do not exceed 5 mg daily in patients with severe renal impairment (creatinine clearance <30 mL/min/1.73 m²) 1
• Do not exceed 5 mg daily in patients with moderate hepatic impairment (Child-Pugh B); solifenacin is not recommended in severe hepatic impairment (Child-Pugh C) 1
• Do not exceed 5 mg daily when used concomitantly with strong CYP3A4 inhibitors 1

Safety Profile at Starting Dose

• The most common adverse events at 5 mg are dry mouth and constipation, which are generally mild to moderate in severity 1, 2
• Discontinuation rates due to adverse events are comparable to placebo at the 5 mg dose 2
• The favorable tolerability profile at 5 mg allows for safe dose escalation when clinically indicated 3

Common Pitfalls to Avoid

• Do not start with 10 mg as initial therapy; always begin with 5 mg to assess tolerability 1
• Do not use solifenacin as monotherapy without first attempting behavioral therapies (bladder training, pelvic floor muscle training, fluid management) as recommended by guidelines 5
• Screen for contraindications before prescribing: urinary retention, gastric retention, uncontrolled narrow-angle glaucoma, and hypersensitivity 1
• Assess post-void residual in patients with obstructive symptoms, history of urinary retention, or neurologic diagnoses before initiating treatment 5