solifenacin
Regulatory sources consulted
Approved indications
- Symptomatic treatment of urge incontinence, urgency, and urinary frequency due to overactive bladder.
Contraindications
Absolute
- Urinary retention, severe gastrointestinal disorder, myasthenia gravis, narrow-angle glaucoma, hemodialysis, severe liver impairment, or hypersensitivity.
- Severe renal or moderate liver impairment together with a strong CYP3A4 inhibitor.
Clinical warnings
- Major warning · QT prolongation and torsades de pointes have been reported, especially with long QT or hypokalemia. — CIMA/AEMPS, ficha técnica 83023
- Major warning · Stop immediately for angioedema with airway involvement or anaphylaxis; monitor urinary and gastrointestinal retention. — CIMA/AEMPS, ficha técnica 83023
Drug interactions
- HighStrong CYP3A4 inhibitors
Mechanism: They may double or triple solifenacin exposure.
Recommendation: Limit to 5 mg/day; the combination is contraindicated with severe renal or moderate liver impairment.
CIMA/AEMPS, ficha técnica 83023https://cima.aemps.es/cima/dochtml/ft/83023/FT_83023.html
- ModerateOther anticholinergics
Mechanism: They increase anticholinergic effects.
Recommendation: Avoid cumulative burden and monitor tolerability.
CIMA/AEMPS, ficha técnica 83023https://cima.aemps.es/cima/dochtml/ft/83023/FT_83023.html
Adverse events
Common (≥1%)
Dry mouth · Constipation · Nausea or dyspepsia · Blurred vision · Drowsiness
Rare but serious
Torsades de pointes ventricular arrhythmia · Anaphylaxis or angioedema · Urinary retention · Ileus or intestinal obstruction
Pregnancy and lactation
Use cautiously during pregnancy and avoid while breastfeeding.
Recent literature (PubMed)
Urinary incontinence remains common in men after prostatectomy. Current guidance suggests early corrective surgery to those that are still incontinent after trying Pelvic Floor Muscle Therapy, however, other treatments are now available. This review aims to evaluate all currently available treatment options for men with post-prostatectomy incontinence (PPI). A search of MEDLINE and CENTRAL databases on 2/2/2021 produced 879 articles. Any study evaluating incontinence before and after a treatment protocol was eligible for inclusion. After screening, 17 randomized control trials were included, and pre-defined data points were collected. Due to heterogeneity, pooled analysis was not possible, and a descriptive synthesis was produced in accordance with PRISMA guidelines. Cochrane Risk of Bias (RoB) tool was used to evaluate all studies. The search protocol and methods for this study was registered on the PROSPERO database before the search began, ID:(CRD42021229749). 3/17(18%) of studies focussed on pharmacotherapy, 2/17(12%) on vibration therapies, 8/17(47%) on pelvic floor muscle therapy (PFMT), 3/17(18%) on electrical stimulation (ES), and 1/17 (6%) on extracorporeal magnetic innervation (ExMI) as their main intervention. The use of Duloxetine, Solifenacin, PFMT, ES, and ExMI all show effective reduction in incontinence in men suffering from PPI. No study in this review evaluated surgical managements for PPI. A large number of treatments are available for PPI using an array of different methods. For this reason, a variety of treatments could be considered before early invasive procedures, to prevent unnecessary surgery and its associated negative complications.
This review aims to assess the efficacy of transcutaneous electrical nerve stimulation (TENS) for neurogenic bladder after spinal cord injury (SCI). A systematic search was conducted of seven electronic data bases from inception to Dec 31, 2022, to identify randomized controlled trials that studied TENS for neurogenic bladder after SCI. The primary outcomes were maximum cystometric capacity (MCC) and residual urine volume (RUV). Secondary outcomes included maximum detrusor pressure, flow rate, and bladder diary. Random effects models were used in all analyses. Eleven trials involving 881 participants were included. Meta-analysis showed that TENS in addition to conventional treatment had larger MCC (mean difference [MD] 50.55 ml, 95% CI 27.81-73.29, p＜0.0001) and lower RUV (MD -22.96 ml, 95% CI -33.45 to -12.47, p＜0.0001) than did conventional treatment only. Compared with magnetic stimulation, no differences were observed with TENS for MCC (MD -14.49 ml, 95% CI -48.97 to 19.98, p = 0.41) and RUV (MD 25 ml, 95% CI -61.79 to 111.79, p = 0.57). There also were no differences in MCC (MD -7.2 ml, 95% CI -14.56 to 0.16, p= 0.06) and (MD -5.2 ml, 95% CI -60.00 to 49.60, p = 0.851) when compared with solifenacin succinate and pelvic floor biofeedback, respectively. TENS may be an effective treatment option for neurogenic bladder after SCI.
bladder based on a systematic review and network meta-analysis approach. Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software. A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache. Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety. RAB32-related Parkinson disease (PARK-RAB32) is clinically indistinguishable from Parkinson disease of unknown cause and is characterized by the cardinal motor manifestations of bradykinesia, rigidity, resting tremor, and postural instability. PARK-RAB32 may also be associated with non-motor features of Parkinson disease, such as olfactor