Antimuscarinic for overactive bladder
ATC code: G04BD08 (Solifenacin)
Brand names
Vesicare, Vesomni
A selective M3 muscarinic antagonist with preferential action on bladder smooth muscle. Reduces involuntary detrusor contractions, urgency, and frequency. Bladder-to-salivary-gland M3 selectivity is roughly 4:1, so dry mouth is less common than with oxybutynin. CYP3A4-metabolized; half-life 45–68 hours.
Second line
Second-line for overactive bladder after behavioral therapy failure (bladder training, caffeine reduction, pelvic floor exercises) per EAU 2024 and AUA 2019. Dose 5 mg once daily; up-titrate to 10 mg if needed. Effect develops over 4 weeks, with assessment at 12 weeks. In the STAR head-to-head trial (Chapple 2005), solifenacin outperformed tolterodine on urgency episodes.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Solifenacin is an antimuscarinic drug. It is prescribed for overactive bladder with frequency and urgency symptoms (AEMPS Ficha Técnica). Solifenacin is prescribed for anti-aging strengthening of the urinary system outside an overactive bladder indication. No clinical studies of prophylactic use in this setting exist. The drug causes anticholinergic adverse effects: dry mouth, constipation, blurred vision, confusion (especially in older adults; the AGS Beers Criteria 2023 lists antimuscarinics as potentially inappropriate for older adults), urinary retention (paradoxically), and QT prolongation. If solifenacin was prescribed outside confirmed overactive bladder, consider seeking a second opinion.
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Limited pregnancy data. OAB in pregnancy usually does not require pharmacotherapy – behavioral measures are first-line. When treatment is needed, deferring initiation until postpartum is preferred.
No data on milk excretion. Not used during lactation.
Solifenacin is evaluated for the following indications with varying evidence strength: Overactive bladder (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Solifenacin (≥ 1 in 100): Dry mouth (10–28%), Constipation, Blurred vision, Drowsiness, Urinary retention, Nausea. See the Safety section for uncommon and serious reactions.
FDA category C. Limited pregnancy data. OAB in pregnancy usually does not require pharmacotherapy – behavioral measures are first-line. When treatment is needed, deferring initiation until postpartum is preferred.
No data on milk excretion. Not used during lactation.
Solifenacin is contraindicated in: Solifenacin hypersensitivity; Severe GI disorders (megacolon, paralytic ileus); Urinary retention; Angle-closure glaucoma; Myasthenia gravis. Full list in the Safety section.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.