SOLIFENACIN SUCCINATE

SOLIFENACIN SUCCINATE
(sol-i-fen'a-sin)
VESIcare
Classifications: anticholinergic; antimuscarinic; antispasmodic;
Therapeutic: antispasmodic

Prototype: Atropine
Pregnancy Category: C

Availability

5 mg, 10 mg tablets

Action

Solifenacin is a selective muscarinic antagonist that depresses both voluntary and involuntary bladder contractions caused by detrusor overactivity.

Therapeutic Effect

Solifenacin improves the volume of urine per void and reduces the frequency of incontinent and urgency episodes.

Uses

Treatment of overactive bladder (OAB) with symptoms of urinary incontinence, urgency, and frequency.

Contraindications

Hypersensitivity to solifenacin or any component of its formulations; severe hepatic impairment; gastric retention; uncontrolled narrow-angle glaucoma; urinary retention; toxic megacolon; GI obstruction; ileus; GERD; pregnancy (category C), lactation.

Cautious Use

Bladder outflow obstruction; concurrent use of ketoconazole or other potent CYP3A4 inhibitors; obstructive disorders; decreased GI motility; hepatic impairment; history of QT prolongation or concurrent use of medications known to prolong the QT interval; controlled narrow-angle glaucoma; renal impairment; renal disease; renal failure; mild to moderate hepatic impairment; older adults.

Route & Dosage

Overactive Bladder
Adult: PO 5 mg once daily; may be increased to 10 mg once daily if tolerated (max of 5 mg/d if taking drugs that inhibit CYP3A4—see Interactions, Drug)

Hepatic Impairment
If moderate hepatic impairment, does not exceed 5 mg/d. If severe hepatic impairment, do not use.

Renal Impairment
Clcr <30 mL/min: max dose 5 mg/d

Administration

Oral
  • Tablets should be swallowed whole.
  • Store at 15–30° C (59–86° F).

Adverse Effects (≥1%)

Body as a Whole: Edema, fatigue. CNS: Dizziness, depression. CV: Hypertension. GI: Dry mouth, constipation , nausea, vomiting, dyspepsia, upper abdominal pain. Respiratory: Cough. Special Senses: Blurred vision, dry eyes. Urogenital: Urinary tract infection, urinary retention.

Interactions

Drug: cyp3a4 inhibitors (e.g., clarithromycin, delavirdine, diltiazem, efavirenz, erythromycin, fluconazole, fluvoxamine, itraconazole, nefazodone, norfloxacin, omeprazole, protease inhibitors, quinine, verapamil, troleandomycin, voriconazole, zafirlukast) may increase levels and toxicity (max dose 5 mg/d); amantadine, amoxapine, bupropion, clozapine, cyclobenzaprine, diphenhydramine, disopyramide, maprotiline, olanzapine, orphenadrine, phenothiazines, tricyclic antidepressants have additive anticholinergic adverse effects. Food: Grapefruit juice may increase solifenacin levels and toxicity.

Pharmacokinetics

Absorption: 90% absorbed from GI tract. Peak: 3–8 h. Metabolism: Extensively metabolized in the liver by CYP3A4. Elimination: Primarily in urine, 22% in feces. Half-Life: 45–68 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor ECG in patients with a known history of QT prolongation or patients taking medications that prolong the QT interval.

Patient & Family Education

  • Stop taking this drug and report to physician if urinary retention occurs.
  • Report promptly any of the following: blurred vision or difficulty focusing vision, palpitations, confusion, or severe dizziness.
  • Report to physician problems with bowel elimination, especially constipation lasting ≥3 d.
  • Exercise caution in hot environments, as the risk of heat prostration increases with this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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