First-lineVesicare
Solifenacin
M3-selective antimuscarinic
First-line pharmacotherapy for overactive bladder in women.
Oral
First-line for
- Overactive bladder / urge incontinence
Mechanism
Selective M3 muscarinic antagonism → ↓ detrusor overactivity without CNS penetration.
"Solifenacin = selective, once-a-day"
- Give 4–6 weeks before judging efficacy
- Watch dry mouth, constipation — top causes of stopping
- Avoid in narrow-angle glaucoma
Dosing
- Start
- 5 mg OD
- Escalate
- 10 mg OD if inadequate at 4 weeks
Contraindications
- AbsoluteUrinary or gastric retention
- AbsoluteNarrow-angle glaucoma
- AbsoluteMyasthenia gravis
Side effects
- Dry mouth
- Constipation
- Blurred vision
- Cognitive slowing (elderly)
- QT prolongation at 10 mg
Fetal & maternal notes
- • Limited pregnancy data — avoid unless benefits clear
Key interactions
Strong CYP3A4 inhibitors (ketoconazole)
Caution↑ solifenacin — cap at 5 mg
Other antimuscarinics
AvoidAdditive toxicity
Clinical pearls
- 💡 Combine with bladder training and pelvic floor exercises
- 💡 If ineffective/intolerable → switch to mirabegron or dual therapy
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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