Solifenacin succinate

How it works

It is a competitive antagonist at muscarinic (predominantly M3) receptors in the detrusor smooth muscle, reducing involuntary bladder contractions and increasing functional bladder capacity.

Prescribing in practice

• Contraindicated in urinary retention, significant gastric outflow obstruction, untreated narrow-angle glaucoma and myasthenia gravis; use cautiously where these risks exist.
• Antimuscarinic load is additive with other anticholinergic drugs, raising the risk of confusion and falls particularly in frail and elderly patients.
• Dose reduction is advised in severe renal impairment and moderate hepatic impairment, and with potent CYP3A4 inhibitors.

Monitoring

Review symptom response and antimuscarinic side effects after a few weeks and assess cumulative anticholinergic burden, especially in older people.

Counselling the patient

• Dry mouth, constipation and blurred vision are common; report difficulty passing urine.
• Swallow tablets whole and report severe abdominal pain or marked constipation.

Evidence & guidelines

NICE guidance positions antimuscarinics such as solifenacin as a core pharmacological option for overactive bladder when conservative measures are insufficient.