Up the Dose and Decrease Bathroom Urge

Overactive bladder patients may benefit from increased solifenacin dose

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Overactive bladder (OAB) can send people to the bathroom multiple times a day. While certain medicines can help, some patients may not respond to a low dose and may feel nervous about stepping up the dose size.

But a recently published study showed that upping the dose of a certain medicine containing solifenacin could benefit patients and keep the bathroom urge to a minimum.

By increasing the dose, patients with OAB can reap a number of benefits in helping their symptoms, researchers said.

"Talk to your doctor about increasing OAB Rx dose."

The aim of the study was to see how overactive bladder symptoms were affected by different doses of the medication solifenacin, more commonly known as Vesicare.

The medicine works as an antimuscarinic agent, which blocks certain nerve signals related to relaxing and slowing heart rate, digestion and other "fight or flight" responses, including bladder control.

Researchers led by Linda Cardozo, MD, from the Department of Urogynaecology at King’s College Hospital in London, randomly divided more than 900 patients with overactive bladder into two groups.

One group was given solifenacin while the other received a fake pill once each day for four months. After two months, participants were able to request an increase in their dose from 5 mg to 10 mg. Neither the patients nor the researchers knew who was receiving which medication.

Previous studies showed that increasing the dose size of solifenicin minimally changed the patient's tolerance toward the drug.

Researchers found that from week 8 to the end of treatment, the number of times patients felt they urgently needed to urinate decreased among those who received the higher dose of solifenacin compared to patients who remained on 5 mg.

How often patients felt they had to go to the bathroom, as well as how urgently they felt they needed to go, decreased among the patients who received the 10 mg dose.

In addition, the number of times patients actually urinated decreased among those given the higher dose of solifenacin.

About 6 percent of the patients who received the higher dose reported new or worsening cases of dry mouth. One patient who remained on the lower dose reported new or worsening dry mouth cases as well.

Researchers noted that more than half of the patients responded to and were satisfied with the 5 mg dose of solifenacin. Less than half the patients given solifenicin had asked to increase their dose at the eight-week mark.

"While, in practice, it would be important to allow a sufficiently long initial treatment period and ensure patient compliance with prescribed therapy before deciding whether to increase the dose, flexible dosing using a self-selection process has the potential to improve outcomes for those with more severe symptoms," researchers wrote in their report.

Participants who requested a dose increase generally had more severe symptoms and didn't respond as well to the 5 mg dose.

The study was published January 7 in BJU International. Astellas Pharma Europe Ltd. funded the study. One of the authors reported working for Advamed, Ethicon, Merck, Pfizer and Teva. Other authors are employees of Astellas.

Reviewed by: 
Review Date: 
January 23, 2013
Last Updated:
January 25, 2013