Issues for surgery
Risk of increased urinary frequency, urgency and urge incontinence if omitted.
Solifenacin and tolterodine – risk of QT-interval prolongation if continued (see Interactions with common anaesthetic agents and Interactions with other common medicines used in the perioperative period).
Combination product containing tamsulosin – risk of hypotension if continued (see Tamsulosin monograph).
Combination product containing tamsulosin – risk of Intraoperative Floppy Iris Syndrome (IFIS) if continued prior to cataract surgery (see Tamsulosin monograph).
Advice in the perioperative period
Elective and emergency surgery
Continue – including the following combination product:
- Solifenacin and tamsulosin (also see Tamsulosin monograph)
Patients undergoing cataract surgery
For combination product containing tamsulosin – ensure the ophthalmologist or cataract surgeon is aware the patient is taking (see Further information).
Post-operative advice
Restart post-operatively when next dose due.
Review if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively.
Review appropriateness of continuing treatment if patient develops post-operative delirium.
Patients undergoing overactive bladder surgery
Review the need for solifenacin post-operatively.
Interactions with common anaesthetic agents
Antimuscarinic action
Antimuscarinic action may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium.
Hypotension
For combination product containing tamsulosin see Tamsulosin drug record.
QT-interval prolongation
Post-marketing reports indicate solifenacin may also prolong the QT-interval. Co-administration with other medicines known to prolong the QT-interval must be based on careful assessment of the potential risks and benefits for each patient.
Anaesthetic agents that may be used in the perioperative period that are known to, or predicted to, prolong the QT-interval include:
- desflurane, isoflurane, sevoflurane*
- thiopental (theoretical)**
*monitor ECG if concurrent use unavoidable; if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia) use greater caution
**monitor ECG with concurrent use if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia).
Interactions with other common medicines used in the perioperative period
Prokinetics
Due to the effect of antimuscarinics on gastro-intestinal motility the effectiveness of prokinetic agents e.g. metoclopramide may be reduced.
Antimuscarinic action
Antiemetics
Also see QT-interval prolongation below.
Antimuscarinic action may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Nefopam
Antimuscarinic action may be additive with nefopam which also has antimuscarinic effects.
Antimicrobials
Also see QT-interval prolongation below.
Clarithromycin (and to a lesser extent erythromycin) is predicted to increase the exposure of solifenacin. Whilst single surgical prophylactic doses should not pose a problem, consult product literature if continued post-operative treatment necessary as depending on the antimuscarinic concomitant use may be contraindicated or require dose reduction or monitoring for adverse effect.
Hypokalaemia
Dexamethasone and hydrocortisone may cause hypokalaemia (potentially increasing the risk of torsades de pointes with solifenacin) – monitor potassium levels. If hypokalaemia occurs, corrective action should be taken and QT-interval monitored.
QT-interval prolongation
Solifenacin may also prolong the QT-interval. Co-administration of solifenacin with medicines known to prolong the QT-interval must be based on a careful assessment of the potential risks and benefits for each patient since the risk of torsade de pointes may increase.
Medicines that may be used in the perioperative period that are known to prolong the QT-interval include:
- ciprofloxacin*
- clarithromycin – see Antimicrobials above
- domperidone – avoid
- droperidol*
- erythromycin (particularly intravenous) – see Antimicrobials above
- granisetron*
- haloperidol – if concurrent use unavoidable monitor ECG for all patients (risk further increased if risk factors present)
- loperamide*
- ondansetron*
- prochlorperazine (theoretical risk)*
*monitor ECG with concurrent use if risk factors for QT-interval prolongation also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia)
Further information
Intraoperative Floppy Iris Syndrome (IFIS)
For combination products containing tamsulosin see Tamsulosin monograph.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 3rd February 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 3rd February 2021]
Summary of Product Characteristics – Solifenacin 5mg Film-Coated Tablets. Genus Pharmaceuticals. Accessed via www.medicines.org.uk 06/11/2020 [date of revision of the text July 2018]
Summary of Product Characteristics – Vesomni® (solifenacin and tamsulosin) 6 mg/0.4 mg modified release tablets®. Astellas Pharma Ltd. Accessed via www.medicines.org.uk 03/02/2021 [date of revision of the text November 2019]