Vesicare (solifenacin succinate)

Vesicare oral tablets contain solifenacin, a competitive muscarinic receptor antagonist. Muscarinic receptors play an important role in several major cholinergically mediated functions, including contractions of urinary bladder smooth muscle. Antagonism at these receptors has been shown to reduce tonus (elastic tension) of the urinary bladder and slow parasympathetic contractions.

It is specifically indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.

Vesicare is administered via an oral tablet of 5 mg once daily, with a possible increase in dosage, to 10 mg once daily, in subjects experiencing good tollerance. Dosing should occur with liquids, and tablets should not be crushed or broken prior to administration.

FDA approval of Vesicare was based upon four 12-week multi-center, double-blind, placebo-controlled, parallel-group studies. The studies enrolled a total of 3027 subjects with at least a 3 month history of increased urinary frequency, urinary urgency, and/or urge or mixed (predominantly urge) incontinence. Subjects in two of the trials received either 5 or 10 mg Vesicare or placebo once daily, and subjects in the other two received exclusively 10 mg or placebo once daily. All patients completing the 12-week studies were eligible to enter an open label long-term extension. All four trials found that Vesicare offered significantly better efficacy than placebo in both primary (mean change from baseline to 12 weeks in number of micturitions/24 hours) and secondary (including mean change from baseline to 12 weeks in number of incontinence episodes/24 hours, and mean volume voided per micturition) endpoints.

Adverse events associated with the use of Vesicare may include, but are not limited to, the following:

• Dry mouth
• Constipation
• Blurred Vission
• Urinary Retention
• Dry Eyes

In addition, three serious intestinal complications (one fecal impaction, one colonic obstruction, and one intestinal obstruction) and one case of angioneurotic edema occurred among patients taking Vesicare in clinical trials. There was not a significant difference in the incidence of serious adverse events between subjects taking the drug for 12 weeks and 12 months.

Solifenacin acts as a direct antagonist at muscarinic acetylcholine receptors in cholinergically innervated organs. Its anticholinergic-parasympatholytic action reduces the tonus of smooth muscle in the bladder, effectively reducing the number of required voids, urge incontinence episodes, urge severity and improving retention, facilitating increased volume per void.

Cardozo L, Lisec M, Millard R, et al. Randomized, double-blind placebo controlled trial of the once daily antimuscarinic agent solifenacin succinate in patients with overactive bladder. Journal of Urology 2004 Nov;172(5 Pt 1):1919-24.

Smulders RA, Krauwinkel WJ, Swart PJ, Huang M. Pharmacokinetics and safety of solifenacin succinate in healthy young men. Journal of Clinical Pharmacology 2004 Sep;44(9):1023-33.

Ohtake A, Ukai M, Hatanaka T,et al. In vitro and in vivo tissue selectivity profile of solifenacin succinate (YM905) for urinary bladder over salivary gland in rats. European Journal of Pharmacology 2004 May 25;492(2-3):243-50.

For additional information regarding Vesicare or overactive bladder, please contact the Vesicare Web Site