Selective M3 muscarinic receptor antagonist
Pregnancy: Avoid — limited data. Not recommended.
Solifenacin
Brand names: Vesicare
Adult dose
Dose: 5 mg once daily; increase to 10 mg if needed
Route: Oral
Frequency: Once daily
Max: 10 mg/day
Overactive bladder (OAB) with urge urinary incontinence: 5 mg OD, increase to 10 mg after 4 weeks if needed. Once daily dosing improves adherence over oxybutynin. Swallow whole — do not crush.
Paediatric dose
Route: Not applicable
Frequency: Not licensed in children
Max: Not applicable
Not licensed for use in children.
Dose adjustments
Renal
Max 5 mg/day if severe renal impairment (eGFR <30).
Hepatic
Max 5 mg/day for moderate hepatic impairment; avoid severe.
Clinical pearls
- More bladder-selective than oxybutynin — better tolerated, less cognitive impairment
- Once-daily dosing improves adherence
- Still carries anticholinergic burden in elderly — consider mirabegron if cognitive concern
- QT prolongation possible — check ECG in high-risk patients (cardiac disease, QT-prolonging drugs)
- Effective for urgency, frequency, and urge incontinence
Contraindications
- Urinary retention
- Narrow-angle glaucoma
- Myasthenia gravis
- Severe GI motility disorders
Side effects
- Dry mouth (common but less than oxybutynin)
- Constipation
- Blurred vision
- Urinary retention
- QT prolongation (less common than tolterodine)
- Cognitive effects (less than oxybutynin due to selectivity)
Interactions
- Strong CYP3A4 inhibitors (ketoconazole, clarithromycin) — max 5 mg (levels increase 3×)
- Other antimuscarinics — additive effects
- QT-prolonging drugs — additive risk
Monitoring
- Urinary symptoms
- Residual urine volume (if symptoms worsen)
- ECG (if cardiac risk factors)
Reference: BNFc; BNF; NICE NG123; EAU Incontinence Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.