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INTRODUCTION

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solifenacin (soe-li-fen-a-sin)

VESIcare

Classification

Therapeutic: urinary tract antispasmodics

Pharmacologic: anticholinergics

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Indications
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Overactive bladder with symptoms (urge incontinence, urgency, frequency).

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Action
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Acts as a muscarinic (cholinergic) receptor antagonist; antagonizes bladder smooth muscle contraction. Therapeutic Effects: Decreased symptoms of overactive bladder.

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Adverse Reactions/Side Effects
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EENT: blurred vision. GI: constipation, dry mouth, dyspepsia, nausea.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of urine retention (difficult urination, painful or distended abdomen). Excessive urinary retention may require dose adjustment by physician.

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Interventions
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  • When appropriate, implement pelvic floor muscle–strengthening activities and other therapeutic exercises to help maintain bladder control.

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Patient/Client-Related Instruction
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  • Advise patient to increase fluid intake and dietary fiber to avoid constipation. Laxatives may also be helpful in patients susceptible to fecal impaction.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged blurred vision or GI problems (nausea, dry mouth, indigestion).

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Pharmacokinetics
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Absorption: Well absorbed (90%).

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Distribution: Unknown.

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Protein Binding: 98%.

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Metabolism and Excretion: Extensively metabolized by the CYP3A4 enzyme system. 69% excreted in urine as metabolites, 22% in feces.

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Half-life: 45–68 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION

PO

unknown

3–8 hr

24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Urinary retention; Gastric retention; Uncontrolled angle-closure glaucoma; Severe hepatic impairment; Lactation.

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Use Cautiously in: Concurrent use of CYP3A4 inhibitors (use lower dose/clinical monitoring may be necessary); Moderate hepatic impairment (lower dose recommended); Renal impairment (dose should not exceed 5 mg/day if CCr < 30 mL/min); Bladder outflow obstruction; GI obstructive disorders, severe constipation or ulcerative colitis; Myasthenia gravis; Angle-closure glaucoma; Children (safety not established); Pregnancy (use only if maternal benefit outweighs fetal risk).

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Interactions
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Drug-Drug: Drugs that induce or inhibit the CYP3A4 enzyme system may significantly alter blood levels of solifenacin; ketoconazole ↑ blood levels and risk of toxicity (do not exceed 5 mg/day).

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Route/Dosage
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PO (Adults): 5 mg once daily, may be ↑ to 10 mg once daily; hepatic impairment/severe renal impairment, concurrent use of ketoconazole or other inhibitors of CYP3A4—dose should not exceed 5 mg/day.

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Availability
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Tablets: 5 mg, 10 mg.

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