solifenacin succinate

Action

Antagonizes muscarinic receptors, reducing urinary bladder smooth-muscle contractions

Availability

Tablets: 5 mg, 10 mg

Indications and dosages

➣ Overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency

Adults: 5 mg P.O. daily initially; may increase to 10 mg P.O. daily if well tolerated

Dosage adjustment

• Moderate hepatic impairment

• Severe renal impairment

• Concurrent use of potent CYP3A4 inhibitors (such as ketoconazole)

Contraindications

• Hypersensitivity to drug or its components

• Urinary retention

• Gastric retention

• Uncontrolled angle-closure glaucoma

Precautions

Use cautiously in:

• hepatic or renal impairment, bladder outflow obstruction, decreased GI motility, GI obstructive disorder, controlled angle-closure glaucoma, congenital or acquired QT interval prolongation

• increased risk of urinary retention or heat prostration

• pregnant or breastfeeding patients

• children (safety and efficacy not established).

Administration

• Give with liquids, with or without food. Make sure patient swallows tablet whole.

Adverse reactions

CNS: dizziness, depression, fatigue, asthenia

CV: hypertension

EENT: dry eyes, blurred vision, dry throat, pharyngitis

GI: nausea, vomiting, constipation, upper abdominal pain, dyspepsia, dry mouth

GU: urinary tract infection, urinary retention

Respiratory: cough

Skin: dry skin, rash, pruritus

Other: influenza, leg or foot edema

Interactions

Drug-drug. Anticholinergics: increased frequency or severity of adverse reactions

CYP3A4 inhibitors (such as ketoconazole): increased solifenacin blood level

Patient monitoring

• Monitor GI, renal, and hepatic function frequently.

• Monitor patient for ophthalmic disorders, especially angle-closure glaucoma. If present, stop drug until condition stabilizes.

Patient teaching

• Instruct patient to take drug with liquids, with or without food, and to swallow tablet whole.

• Advise patient to contact prescriber if severe abdominal pain or constipation lasting 3 or more days occurs.

• Caution patient to avoid driving and other hazardous activities until drug effects are known.

• Advise patient of risk for heat prostration; describe symptoms.

• Instruct patient to consult prescriber before taking over-the-counter products such as antihistamines because these may increase risk of side effects.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.