Anticholinergic·Urology

Solifenacin

Overactive bladder syndrome (urge incontinence, urgency, frequency)

Authority requiredPBSANTICHOLINERGICVesicare5 mg tablet+2

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At a glance

Max Dose

10 mg/day

Half-life

45-68 h

M3 Selective

YES

Caution: Renal Adj.

DOSE RED.

Cautions

Avoid / Cautions

Urinary retention, uncontrolled narrow-angle glaucoma, toxic megacolon. Pregnancy Category B3.

Where it stands

Rapid Summary

Overview

Modern, bladder-selective antimuscarinic. Substantially better tolerated than Oxybutynin due to high affinity for the M3 receptor subtype located in the detrusor muscle.

Clinical Focus

Provides excellent overactive bladder relief with a fraction of the dry mouth and cognitive side effects of older agents.

Bottom Line

Solifenacin is a better-tolerated antimuscarinic for overactive bladder than oxybutynin, but still carries anticholinergic risk in elderly and is contraindicated in uncontrolled narrow-angle glaucoma.

Formulation & Access

Brand Names

Vesicare

Oral Routes

Tablets (5 mg, 10 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Overactive bladder syndrome (urge incontinence, urgency, frequency).

Clinical Place

Preferred first-line antimuscarinic for OAB due to OD dosing and superior tolerability profile.

Quick reference

Class & Role

Anticholinergic — Modern, bladder-selective antimuscarinic.

Route / Formulation

Tablets (5 mg, 10 mg). (Vesicare)

Usual Dose & Max

PO 5 mg OD. May increase to Max 10 mg/day.

Key Indication Doses

Overactive Bladder: PO 5 mg OD. May increase to Max 10 mg/day. Renal / Hepatic Impairment: Max 5 mg/day if eGFR < 30 or in moderate hepatic impairment.

Best Uses

Key Risks

Gastrointestinal: Dry mouth, constipation (both significantly less severe than Oxybutynin but still common). Ocular: Blurred vision. Cardiovascular: Mild QTc prolongation (rarely clinically significant unless combined with other agents).

Key Interactions

Heavily metabolised by CYP3A4. Strong inhibitors (Ketoconazole, Ritonavir) mandate a maximum dose of 5 mg/day to prevent toxicity. Additive anticholinergic effects with TCAs/antipsychotics.

Monitoring

Bladder scans if the patient complains of straining or feeling incomplete emptying. Monitor bowel charts. Check eGFR and LFTs to ensure the 10 mg dose is safe.

Clinical Pearl

Unlike Oxybutynin which works relatively quickly, Solifenacin takes up to 4 weeks to reach maximum efficacy. Do not escalate to 10 mg too early; give the 5 mg dose time to work.

Access

Authority requiredVesicare5 mg tablet

Brand: Vesicare
PBS status: Authority required
Formulation: Tablets (5 mg, 10 mg).

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