Solifenacin
VESICARE
Pronunciation: sol-i-FEN-a-sin (VES-i-kair)
“Solar fencin’ Vesica cares”
“red as a beet” → anticholinergic
asterisk → no mad hatter hat → minimal CNS effects due to minimal blood-brain barrier penetration
What it isM3-preferring muscarinic antagonist; overactive bladder.
Why this oneThe 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.
Solifenacin prescription history
Animated chart of estimated U.S. prescriptions per year, Overactive bladder meds (1970–2026). Solifenacin enters in 2005 (estimated).
FDA-approved for
- overactive bladder (2004)
Principal riskAnticholinergic burden and QT prolongation
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.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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
Available strengths
- tab 5, 10 mg
- ER tab 10 mg
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
Cost
Generic entry2014
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Memory aids: interaction avatars
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Self-check
- Which drug is specifically labeled in combination with solifenacin?
Mirabegron. - Which metabolic pathway makes solifenacin interaction-sensitive?
CYP3A4.