Solitral

Uses

Alfuzosin Hydrochloride is used for the treatment of the signs and symptoms of benign prostatic hyperplasia(BPH), lower urinary tract symptoms (LUTS) including urinary frequency, nocturia, incomplete emptying and urinary hesitancy associated with BPH.

Symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency as may occur in patients with overactive bladder syndrome.

Solitral is also used to associated treatment for these conditions: Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH), Urinary Bladder, Overactive

How Solitral works

Alpha(1)-adrenoreceptors are found in the prostate, bladder base, bladder neck, prostatic capsule, and prostatic urethra; their activation may lead to contraction of smooth muscle and urinary symptoms in patients with BPH. Alfuzosin selectively binds to and inhibits alpha(1)-adrenergic receptors in the lower urinary tract. This leads to the relaxation of smooth muscle in both the prostate and bladder neck, resulting in the improvement in urine flow and a reduction of urinary symptoms.

Solifenacin is a competitive muscarinic receptor antagonist. It has the highest affinity for M3, M1, and M2 muscarinic receptors. 80% of the muscarinic receptors in the bladder are M2, while 20% are M3. Solifenacin's antagonism of the M3 receptor prevents contraction of the detrusor muscle, while antagonism of the M2 receptor may prevent contraction of smooth muscle in the bladder.

Dosage

Solitral dosage

The recommended dosage is one 10 mg Alfuzosin Hydrochloride tablet daily to be taken immediately after the same meal each day. The tablets should not be chewed or crushed.

Adults, including the elderly: The recommended dose is Solifenacin Succinate 5 mg once daily. If needed, the dose may be increased to Solifenacin Succinate 10 mg once daily.

Children and adolescents: Safety and effectiveness in children have not yet been established. Therefore, Solifenacin Succinate should not be used in children.

Alfuzosin Hydrochloride tablet should be swallowed whole.

Side Effects

This formulation is generally well tolerated. However the following adverse events have been reported include abdominal pain, dyspepsia, constipation, nausea, impotence, bronchitis, sinusitis and pharyngitis.

The most common side effects are blurred vision, dry mouth, constipation & heat prostration. Other side effects include dizziness, fatigue, edema, palpitation and skin reactions. Disorientation, hallucination and convulsion may occur.

Toxicity

The oral LD50 of alfuzosin is 2300 mg/kg in male mice and 1950 mg/kg in female mice. An overdose of alfuzosin can cause hypotension. Cardiovascular support should be initiated immediately. The patient should be kept in the supine position to aid in restoring pressure and managing heart rate. Fluid resuscitation should also be considered in severe cases; sometimes, vasopressors are required. Renal function should be monitored frequently. Dialysis may not be of benefit to alfuzosin protein binding of up to 90%.

The LD₅₀ of Solifenacin has yet to be determined.

Signs of overdose include severe anticholinergic effects, mental status changes, and decreased consciousness. In case of overdose, treat patients with gastric lavage and supportive measures. Monitor patients with an ECG.

Precaution

Alfuzosin Hydrochloride should not be given to patients with moderate or severe hepatic insufficiency. Caution should be exercised when Alfuzosin is administered in patients with severe renal insufficiency. If symptoms of angina pectoris should newly appear or worsen, Alfuzosin Hydrochloride should be discontinued.

Other causes of frequent urination (heart failure or renal disease) should be assessed before treatment with Solifenacin. If urinary tract infection is present, an appropriate antibacterial therapy should be started. Solifenacin Succinate should be used with caution in patients with clinically significant bladder outflow obstruction at risk of urinary retention, gastrointestinal obstructive disorders, risk of decreased gastrointestinal motility, severe renal impairment (creatinine clearance 30 ml/min), moderate hepatic impairment, concomitant use of a strong CYP3A4 inhibitor, e.g. ketoconazole

Interaction

Alfuzosin may interact with other alpha-blockers, Atenolol, Cimetidine, Diltiazem, Ketoconazole and Ritonavir.

Concomitant medication with other drugs with anticholinergic properties may result in more pronounced therapeutic effects and side effects. The therapeutic effect of solifenacin may be reduced by concomitant administration of cholinergic receptor agonists. Solifenacin can reduce the effect of drugs that stimulate the motility of the gastro-intestinal tract, such as metoclopramide and cisapride. Ketoconazole & other CYP3A4 inhibitors increase the plasma concentration of solifenacin.

Volume of Distribution

The volume of distribution of alfuzosin after intravenous administration in healthy volunteers is about 3.2 L/kg. Alfuzosin distributes heavily to the tissues of the prostate.

The volume of distribution of solifenacin is 600L.

Elimination Route

Alfuzosin is readily absorbed in the gastrointestinal tract and the absolute bioavailability under fed conditions is 49%. In patients over 75 years of age, alfuzosin is absorbed more rapidly and peak plasma levels are higher. One source mentions a bioavailability of 64%. After multiple doses under fed conditions, Cmax is achieved in 8 hours. Cmax and AUC0-24 values are about 13.6 ng/mL and 194 ng·h/mL, respectively. Steady-state plasma concentrations are achieved after the second dose and are 1.2 to 1.6 times higher than after a single dose. With the extended-release formulation, alfuzosin release is sustained over 20 hours with a rate of dissolution ranging between 2 and 12 hours.

Solifenacin is well absorbed in the duodenum, jejunum, and ileum but not the stomach. Absorption occurs via passive diffusion and so no transporters are involved. The mean oral bioavailability of solifenacin is 88%. The T_max of solifenacin is 3-8 hours with a C_ss of 32.3ng/mL for a 5mg oral dose and 62.9ng/mL for a 10mg oral dose.

Half Life

The apparent elimination half-life of alfuzosin after oral administration is about 10 hours. The terminal half-life is 3-5 hours.

The elimination half life of solifenacin ranges from 33-85 hours.

Clearance

Exercise caution if renal clearance is < 30 mL/min. The clearance of alfuzosin is increased in renal insufficiency (with or without dialysis), due to an increase in the free fraction.

The clearance of solifenacin is 7-14L/h and a renal clearance of 0.67-1.51L/h.

Elimination Route

It is partially metabolised and excreted mainly in the bile and faeces. Following oral administration of a radiolabeled alfuzosin solution, the detection of radioactivity after one week was 69% in the feces and 24% in the urine.

69.2±7.8% of a radiolabelled dose is recovered in the urine, 22.5±3.3% was recovered in feces, and 0.4±7.8% was recovered in exhaled air. 18% of solifenacin is eliminated as the N-oxide metabolite, 9% is eliminated as the 4R-hydroxy N-oxide metabolite, and 8% is eliminated as the 4R-hydroxy metabolite.

Pregnancy & Breastfeeding use

Alfuzosin Hydrochloride is not indicated for use in pregnant and lactating mother.

Use in pregnancy: There are no adequate data from the use of solifenacin succinate in pregnant women. Caution should be exercised while prescribing solifenacin to pregnant women.

Use in lactating mother: No data concerning the excretion of solifenacin into breast milk are available. The use of Solifenacin is avoided in lactating mother.

Contraindication

Alfuzosin Hydrochloride tablet is contraindicated for hypersensitivity to Alfuzosin Hydrochloride, history of orthostatic hypotension, combination with other alpha-1 receptor blockers, hepatic insufficiency.

Solifenacin is contraindicated in patients with hypersensitivity to solifenacin or to any of the excipients. It is also contraindicated in myasthenia gravis, urinary retention, uncontrolled narrow angle glaucoma, severe gastro-intestinal condition (including toxic megacolon), patients undergoing haemodialysis, patients with severe hepatic impairment, patients with severe renal impairment or moderate hepatic impairment and on treatment with a strong CYP3A4 inhibitor, e.g. ketoconazole.

Special Warning

Efficacy of Alfuzosin Hydrochloride has not been demonstrated in children aged 2 to 16 years. Therefore Alfuzosin Hydrochloride is not indicated for use in the paediatric population.

Patients with renal impairment: No dosage adjustment is necessary for patients with mild to moderate renal impairment (creatinine clearance > 30 ml/min). Patients with severe renal impairment (creatinine clearance 30 ml/min) should be treated with caution and receive no more than 5 mg Solifenacin SuccinateTablet once daily.

Patients with hepatic impairment: No dosage adjustment is necessary for patients with mild hepatic impairment. Patients with moderate hepatic impairment should be treated with caution and receive no more than 5 mg Solifenacin SuccinateTablet once daily.

Patients taking CYP3A4 inhibitors concomitantly: The maximum dose of Solifenacin Succinateshould be limited to 5 mg when treated simultaneously with ketoconazole or other potent CYP3A4 inhibitors e.g. ritonavir, nelfinavir or itraconazole.

Use in children: Safety and efficacy of solifenacin in children have not been established.

Acute Overdose

Overdose of Alfuzosin Hydrochloride should lead to hypotension; support of the cardiovascular system is of first importance. Restoration of blood pressure and normalization of heart rate may be accomplished by keeping the patient in the supine position. If this measure is inadequate, then the administration of intravenous fluids should be considered. If necessary, vasopressors should then be used, and the renal function should be monitored and supported as needed.

Storage Condition

Store in a cool and dry place, protected from light

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