form of both agents. Use Caution/Monitor. solifenacin decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor. promethazine increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. solifenacin and promethazine both decrease QTc interval. Use Caution/Monitor.propafenoneSerious - Use Alternative (1)solifenacin and propafenone both increase QTc interval. Avoid or Use Alternate Drug.propanthelineMonitor Closely (1)propantheline and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.protriptylineMonitor Closely (2)solifenacin and protriptyline both increase QTc interval. Use Caution/Monitor. solifenacin and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.pyridostigmineMonitor Closely (1)pyridostigmine increases and solifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.quetiapineMonitor Closely (3)solifenacin decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor. quetiapine increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.Serious - Use Alternative (1)solifenacin and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.quinidineMonitor Closely (1)solifenacin and quinidine both increase QTc interval. Use Caution/Monitor.quinineMonitor Closely (1)solifenacin and quinine both increase QTc interval. Use Caution/Monitor.quinupristin/dalfopristinMonitor Closely (1)quinupristin/dalfopristin will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ranolazineMonitor Closely (1)solifenacin and ranolazine both increase QTc interval. Use Caution/Monitor.rapacuroniumMonitor Closely (1)rapacuronium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.revefenacinSerious - Use Alternative (1)revefenacin and solifenacin both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.ribociclibMonitor Closely (1)ribociclib will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)ribociclib increases toxicity of solifenacin by QTc interval. Avoid or Use Alternate Drug.rifabutinSerious - Use Alternative (1)rifabutin will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.rifampinSerious - Use Alternative (1)rifampin will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.rifapentineMonitor Closely (1)rifapentine will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rilpivirineMonitor Closely (1)solifenacin and rilpivirine both increase QTc interval. Use Caution/Monitor.risperidoneMonitor Closely (4)solifenacin decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor. risperidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. solifenacin and risperidone both increase QTc interval. Use Caution/Monitor.ritonavirMonitor Closely (1)ritonavir will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rivastigmineMonitor Closely (1)solifenacin decreases effects of rivastigmine by cholinergic effects/transmission. Use Caution/Monitor.rocuroniumMonitor Closely (1)rocuronium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.romidepsinMonitor Closely (1)solifenacin and romidepsin both increase QTc interval. Use Caution/Monitor.rucaparibMonitor Closely (1)rucaparib will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.rufinamideMonitor Closely (1)rufinamide will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.saquinavirSerious - Use Alternative (2)saquinavir increases levels of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Increased risk of PR or QT prolongation and cardiac arrhythmias. solifenacin and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.scopolamineMonitor Closely (1)scopolamine and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.secretinSerious - Use Alternative (1)solifenacin decreases effects of secretin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Concomitant use of anticholinergic drugs may cause a hyporesponse to stimulation testing with secretin. Discontinue anticholinergic drugs at least 5 half-lives before administering secretin.selpercatinibMonitor Closely (1)selpercatinib increases toxicity of solifenacin by QTc interval. Use Caution/Monitor.sertralineMonitor Closely (1)sertraline and solifenacin both increase QTc interval. Use Caution/Monitor.sevofluraneSerious - Use Alternative (1)sevoflurane and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.siponimodSerious - Use Alternative (2)siponimod and solifenacin both increase QTc interval. Avoid or Use Alternate Drug. solifenacin and siponimod both increase QTc interval. Avoid or Use Alternate Drug.sorafenibMonitor Closely (1)sorafenib and solifenacin both increase QTc interval. Use Caution/Monitor.sotalolSerious - Use Alternative (1)solifenacin and sotalol both increase QTc interval. Avoid or Use Alternate Drug.St John's WortSerious - Use Alternative (1)St John's Wort will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.stiripentolMonitor Closely (1)stiripentol, solifenacin. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.succinylcholineMonitor Closely (1)succinylcholine increases and solifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.sunitinibMonitor Closely (2)solifenacin and sunitinib both increase QTc interval. Use Caution/Monitor. sunitinib and solifenacin both increase QTc interval. Use Caution/Monitor.tacrolimusMonitor Closely (2)tacrolimus and solifenacin both increase QTc interval. Use Caution/Monitor. solifenacin and tacrolimus both increase QTc interval. Use Caution/Monitor.tazemetostatMonitor Closely (1)tazemetostat will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimatMonitor Closely (1)tecovirimat will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.telavancinMonitor Closely (1)solifenacin and telavancin both increase QTc interval. Use Caution/Monitor.tetrabenazineSerious - Use Alternative (1)solifenacin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.thioridazineContraindicated (1)solifenacin and thioridazine both increase QTc interval. Contraindicated.Monitor Closely (3)solifenacin decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor. thioridazine increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.thiothixeneMonitor Closely (4)solifenacin decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. solifenacin and thiothixene both increase QTc interval. Use Caution/Monitor.tiotropiumMonitor Closely (1)solifenacin and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.tipranavirSerious - Use Alternative (1)tipranavir will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.tolterodineMonitor Closely (1)solifenacin and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.topiramateMonitor Closely (1)topiramate will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.toremifeneSerious - Use Alternative (1)solifenacin and toremifene both increase QTc interval. Avoid or Use Alternate Drug.trazodoneMonitor Closely (1)solifenacin and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.Serious - Use Alternative (1)solifenacin and trazodone both increase QTc interval. Avoid or Use Alternate Drug.triclabendazoleMonitor Closely (1)solifenacin and triclabendazole both increase QTc interval. Use Caution/Monitor.trifluoperazineMonitor Closely (4)solifenacin decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor. trifluoperazine increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. solifenacin and trifluoperazine both decrease QTc interval. Use Caution/Monitor.trihexyphenidylMonitor Closely (1)solifenacin and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimipramineMonitor Closely (2)solifenacin and trimipramine both increase QTc interval. Use Caution/Monitor. solifenacin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.triptorelinMonitor Closely (1)solifenacin and triptorelin both increase QTc interval. Use Caution/Monitor.trospium chlorideMonitor Closely (1)solifenacin and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.tucatinibSerious - Use Alternative (1)tucatinib will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (2)solifenacin increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated. solifenacin, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.valbenazineMonitor Closely (1)valbenazine and solifenacin both increase QTc interval. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)solifenacin and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.vardenafilMonitor Closely (1)solifenacin and vardenafil both increase QTc interval. Use Caution/Monitor.vecuroniumMonitor Closely (1)solifenacin and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.vemurafenibSerious - Use Alternative (1)solifenacin and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.venlafaxineMonitor Closely (1)solifenacin and venlafaxine both decrease QTc interval. Use Caution/Monitor.verapamilMonitor Closely (1)verapamil will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)solifenacin increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.voclosporinMonitor Closely (1)voclosporin, solifenacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)voriconazole will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)solifenacin and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.vorinostatMonitor Closely (2)solifenacin and vorinostat both increase QTc interval. Use Caution/Monitor. vorinostat and solifenacin both increase QTc interval. Use Caution/Monitor.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.zafirlukastMonitor Closely (1)zafirlukast will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ziprasidoneMonitor Closely (3)solifenacin decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor. ziprasidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.Serious - Use Alternative (1)solifenacin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zotepineMonitor Closely (2)solifenacin decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. solifenacin decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. >10% tablets Dry mouth (10.6-27.6%) Constipation (5.4-13.4%) 1-10% tablets Blurred vision (3.8-4.8%) Urinary tract infection NOS (2.8-4.8%) Dyspepsia (1.4-3.9%) Nausea (1.7-3.3%) Influenza (0.9-2.2%) Fatigue (1-2.1%) Dizziness (1.8-1.9%) Upper abdominal pain (1.2-1.9%) Dry eyes NOS (0.3-1.6%) Urinary retention (1.4%) Hypertension NOS (0.5-1.4%) Depression NOS (0.8-1.2%) Edema lower limb (0.3-1.1%) Vomiting (0.2-1.1%) Cough (0.2-1.1%) Oral suspension Constipation (7.4%) Dry mouth (3.2%) Urinary tract infection (2.1%) Abdominal pain (1.1%) Positive urinalysis bacterial test (1.1%) Somnolence (1.1%) Postmarketing Reports General disorders and administration site conditions: Peripheral edema, hypersensitivity reactions (including angioedema with airway obstruction, rash, pruritus, urticaria, anaphylactic reaction) Nervous system disorders: Dizziness, headache, confusion, hallucinations, delirium, somnolence Cardiac disorders: QT prolongation, torsade de pointes, atrial fibrillation, tachycardia, palpitations Hepatobiliary disorders: Liver disorders mostly characterized by abnormal liver function tests (ie, AST, ALT, GGT) Renal and urinary disorders: renal impairment, urinary retention Metabolism and nutrition disorders: Decreased appetite, hyperkalemia Skin and subcutaneous tissue disorders: Exfoliative dermatitis, erythema multiforme, dry skin Eye disorders: Glaucoma Gastrointestinal disorders: Gastroesophageal reflux disease, ileus, vomiting, abdominal pain, dysgeusia, sialadenitis Respiratory, thoracic and mediastinal disorders: Dysphonia, nasal dryness Musculoskeletal and connective tissue disorders: Muscular weakness Contraindications Hypersensitivity Gastric retention Uncontrolled narrow-angle glaucoma tablets only Urinary retention Cautions Reports of angioedema of face, lips and/or larynx, in some cases occurring after the first dose, described; anaphylactic reactions reported rarely Administer with caution with clinically significant bladder outflow obstruction Caution with decreased gastrointestinal motility Somnolence reported; advise patients not to drive or operate heavy machinery until they know how therapy affects them Caution in patients being treated for narrow-angle glaucoma Caution with a known history of QT prolongation or patients who are taking medications known to prolong the QT interval Associated with antimuscarinic CNS adverse reactions; monitor for signs of antimuscarinic CNS adverse reactions, particularly after beginning treatment or increasing the dose Drug interaction overview Solifenacin is a CYP3A4 substrate Coadministration of ketoconazole, a strong CYP3A4 inhibitor, significantly increased the exposure of solifenacin; modify solifenacin dose if coadministered with strong CYP3A4 inhibitors Pregnancy There are no studies on use in pregnant