Solifenacin
VESICARE
What it isM3-preferring muscarinic antagonist; overactive bladder.
Why this oneIt is the antimuscarinic specifically labeled with mirabegron when either mechanism alone is inadequate.
What limits itStill anticholinergic, so cognition and constipation matter in the elderly. QT prolongation; CYP3A4 substrate.
FDA-approved for
- overactive bladder (2004)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Overactive bladder | Adults | 5 mg QD | 5 mg QD (may increase to 10 mg QD if tolerated) | 10 mg QD |
Renal Severe impairment (CLcr <30): do not exceed 5 mg QD
Hepatic Moderate (Child-Pugh B): do not exceed 5 mg QD; severe (Child-Pugh C): not recommended
Instructions
- Take with water and swallow whole
- May take with or without food
Contraindications
- Urinary retention
- Gastric retention
- Uncontrolled narrow-angle glaucoma
Cautions
- Angioedema and anaphylactic reactions
- Urinary retention — not recommended in clinically significant bladder outlet obstruction
- Decreased GI motility
- CNS effects / somnolence
- Use caution in controlled narrow-angle glaucoma
- QT prolongation in patients at high risk
Adverse reactions
- Dry mouth
- Constipation
- Urinary tract infection
- Blurred vision
Pregnancy No human data; animal developmental toxicity and reduced fetal weight at higher doses
Lactation No human data; present in mouse milk
NO BOXED WARNINGS
Principal riskAnticholinergic burden and QT prolongation
Cost, est. cash$5–$150/month
Generic entry2014
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Solifenacin ballicule
Open Solifenacin in the interactive console ↗
Memory aids: mascots and interaction avatars
“red as a beet” → anticholinergic
asterisk → no mad hatter hat → minimal CNS effects due to minimal blood-brain barrier penetration
