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Toviaz vs Vesicare
Introduction
For patients dealing with overactive bladder (OAB) or other urinary symptoms, certain drugs that affect the contraction and relaxation of the muscles in the bladder can help manage these symptoms. Toviaz and Vesicare are two such drugs prescribed for this purpose. Both have effects on the muscarinic receptors present in our bodies which control various automatic processes including bladder function. Toviaz is known as a selective muscarinic receptor antagonist, specifically affecting M3 receptors which play an important role in controlling urinary urgency, while Vesicare has similar properties but it affects all five subtypes of muscarinic receptors to varying degrees providing broader coverage. However, different individual responses may occur due to genetic variation among patients.
Toviaz vs Vesicare Side By Side
| Attribute | Toviaz | Vesicare |
|---|---|---|
| Brand Name | Toviaz | Vesicare |
| Contraindications | Potent CYP3A4 inhibitors, uncontrolled narrow-angle glaucoma, slow gastric emptying (gastroparesis), urinary retention | Potent CYP3A4 inhibitors, uncontrolled narrow-angle glaucoma, slow gastric emptying (gastroparesis), urinary retention |
| Cost | Around $390 for 30 tablets of 4 mg | Around $420 for 30 tablets of 5 mg, Generic version: $50-$80 for 30 tablets |
| Generic Name | Fesoterodine | Solifenacin |
| Most Serious Side Effect | Allergic reaction, severe skin reactions, blurred vision with eye pain or swelling, heart issues, low sodium levels, serious nervous system reaction | Allergic reaction, severe skin reaction, changes in vision or eye pain, little or no urination, dehydration symptoms, severe stomach pain with constipation |
| Severe Drug Interactions | Potent CYP3A4 inhibitors | Potent CYP3A4 inhibitors |
| Typical Dose | 4–8 mg/day | 5 mg per day, can be increased to 10 mg/day |
What is Toviaz?
Fesoterodine (the generic name for Toviaz) was a significant advancement in the class of medications known as antimuscarinics, which are used to treat overactive bladder syndrome. Fesoterodine was first approved by the FDA in 2008. Toviaz works by blocking the action of acetylcholine on muscarinic receptors in the bladder, therefore reducing involuntary muscle contractions and increasing bladder capacity, effectively prolonging the time between needing to urinate. Solifenacin (Vesicare) also belongs to this class of drugs but differs slightly from Fesoterodine.
Unlike Toviaz that is metabolized into its active form right after ingestion, Vesicare remains unchanged throughout its entire course inside one's body. Both these medicines may cause side effects such as dry mouth and constipation; however, they tend not to influence other bodily systems significantly due their selective focus on urinary tract function.
What conditions is Toviaz approved to treat?
Toviaz has been approved for the treatment of certain urinary conditions, including:
- Overactive bladder with symptoms of urge urinary incontinence
- Urgency
- Frequency
It is designed to relax the muscles in the bladder and improve your ability to control urination.
How does Toviaz help with these illnesses?
Toviaz works to manage overactive bladder by increasing the amount of acetylcholine available in the synapses of the bladder muscles. It does this by blocking it from being reabsorbed, so levels can be maintained higher for longer periods of time. Acetylcholine is a neurotransmitter, a chemical that acts as a messenger in the brain and throughout the body, that plays an important role in muscle contraction and relaxation, amongst other things. People with overactive bladders often have relatively lower levels of acetylcholine. Therefore, by increasing acetylcholine availability, Toviaz can limit the negative effects of an overactive bladder and help patients manage their condition more effectively.
What is Vesicare?
Vesicare, which is a brand name for solifenacin, operates as a competitive cholinergic receptor antagonist, selective for the M3 receptor subtype. The M3 receptors are involved in contraction of human bladder and gastrointestinal smooth muscle, saliva production, and iris sphincter function. This means it blocks the action of acetylcholine at muscarinic receptors in the bladder, thus reducing contractions that cause urgency.
Solifenacin was first approved by the FDA in 2004. It doesn't inhibit serotonin reuptake because it isn't an SSRI antidepressant. Its distinct mechanism results in a unique side-effect profile compared to drugs like Toviaz (fesoterodine). Notably, Vesicare does not commonly lead to sedation or weight gain—typical side effects associated with SSRIs—but dry mouth and constipations can occur due to its antimuscarinic effects.
The ability of Vesicare to act on M3 receptor can be beneficial particularly for patients suffering from overactive bladder syndrome who don't respond well to other treatments such as fesoterodine.
What conditions is Vesicare approved to treat?
Vesicare is authorized for use in managing the following conditions:
- Overactive bladder with symptoms of urinary frequency, urgency or urge incontinence
- Increased nighttime urination (nocturia), a common symptom associated with overactive bladder.
How does Vesicare help with these illnesses?
Vesicare, like Toviaz, is a medication used to manage overactive bladder symptoms such as urinary incontinence, urgency and frequency. These medications operate by blocking the action of acetylcholine, a neurotransmitter that triggers muscle contractions in the bladder. Vesicare specifically works by inhibiting muscarinic receptors which are responsible for bladder muscle contractions. This results in relaxation of the detrusor muscle of the bladder and an increase in its storage capacity thereby reducing episodes of urinary urgency and leakage. While both Toviaz and Vesicare are effective treatments for overactive bladder symptoms, Vesicare has a longer half-life than Toviaz which can potentially result in more sustained symptom relief throughout the day.
How effective are both Toviaz and Vesicare?
Both fesoterodine (Toviaz) and solifenacin (Vesicare) have been widely used in managing overactive bladder symptoms, with the FDA approval for Toviaz coming a few years after Vesicare. As they both function as antimuscarinic agents, their prescribing depends on individual patient conditions and preferences. A direct comparison study conducted in 2008 found that both drugs had similar efficacy in managing overactive bladder symptoms, showcasing promising safety profiles. The metrics studied to measure efficacy showed no significant differences between patients receiving Toviaz or Vesicare.
A 2011 meta-analysis of studies involving fesoterodine demonstrated its effectiveness in reducing urinary frequency and urgency from the first week of treatment onwards. Its side effect profile was comparable to other antimuscarinics, and it was well-tolerated across age groups including older adults. Fesoterodine has become one of the popular choices for treating overactive bladder due to its consistent release mechanism which allows once-daily dosing.
A review conducted in 2016 indicated that solifenacin appears more effective than placebo for improving storage symptoms related to an overactive bladder while maintaining a similar safety profile with other antimuscarinics. It's typically considered as a second-line treatment option following behavioral modifications or pelvic floor muscle training interventions when these methods prove insufficiently effective alone. However, data confirming its efficacy as standalone therapy is somewhat less robust than that provided by trials combining it with another intervention such as mirabegron. Nonetheless, because of solifenacin’s selective binding affinity towards M3 receptors located predominantly within the detrusor muscle of the urinary bladder wall, it may be a preferred choice for those who have not responded well to other treatments or seek reduced systemic side effects often associated with non-selective antimuscarinics like dry mouth and constipation.
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At what dose is Toviaz typically prescribed?
Oral dosages of Toviaz range from 4–8 mg/day, but research suggests that starting with a 4 mg/day dose is effective for managing symptoms of overactive bladder in most people. If necessary, the dose can be increased to 8 mg/day after an evaluation period if there is no satisfactory response. The maximum dosage that should not be exceeded in any case is 8 mg/day. Please note, this medication isn't generally recommended for children and adolescents under the age of 18 years.
At what dose is Vesicare typically prescribed?
Vesicare treatment for overactive bladder typically commences with a dosage of 5 mg per day. If necessary, your doctor could increase this to 10 mg/day after evaluating your response and tolerance to the medication. The dose should be taken once daily, ideally at the same time every day. It's essential not to exceed the maximum recommended dose of 10 mg/day due to an increased risk of side effects such as dry mouth or constipation. As Vesicare may take several weeks before its full benefits are felt, it is important that you continue taking it even if no immediate improvement is noticed.
What are the most common side effects for Toviaz?
Common side effects seen with Toviaz include:
- Dry mouth
- Constipation
- Urinary tract infection
- Blurred vision
- Dizziness, sleepiness/drowsiness
- Upset stomach or indigestion
- Dry eyes
- Back pain
While the common side effects of Vesicare are similar to those of Toviaz, there might be additional symptoms such as:
- Heat exhaustion or heat-stroke in hot weather
Always consult a healthcare professional if you experience any unusual symptoms while taking these medications.
Are there any potential serious side effects for Toviaz?
While Toviaz and Vesicare are generally well-tolerated, they can occasionally cause severe side effects:
- Allergic reaction signs such as difficulty breathing, hives, swelling in your face or throat
- Severe skin reactions including fever, sore throat, burning eyes, skin pain followed by a red or purple rash that spreads (particularly in the face or upper body) causing blistering and peeling
- Blurred vision which could be accompanied with eye pain or swelling; this may lead to seeing halos around lights
- Heart issues like rapid heartbeats or fluttering sensation in your chest. These symptoms may also come with shortness of breath and sudden dizziness
- Low sodium levels leading to headache, confusion, slurred speech, severe weakness loss of coordination and an unsteady feeling
- Serious nervous system reaction - rigid muscles high fever sweating fast uneven heartbeats tremors often giving you a feeling you might faint.
If you experience any of these symptoms while using Toviaz or Vesicare seek immediate medical attention.
What are the most common side effects for Vesicare?
While taking Vesicare, users might experience the following side effects:
- Dry mouth and throat
- Constipation or upset stomach
- Blurred vision
- Dizziness or headache
- Heat sensitivity and excessive sweating
- Sleep disturbances such as insomnia
- Mild confusion at times
- A racing heartbeat or palpitations
Rash on skin
Unusual weight changes
Increased urge to urinate
Are there any potential serious side effects for Vesicare?
While Vesicare generally has a good safety profile, it's important to be aware of potential side effects. These can include:
- Signs of an allergic reaction such as difficulty breathing; swelling of your face, lips, tongue or throat
- A severe skin reaction that includes symptoms like fever, sore throat, burning in the eyes, skin pain followed by a red or purple skin rash that spreads and causes blistering and peeling
- Changes in vision or eye pain
- Little or no urination which may result from kidney problems
- Dehydration symptoms - feeling very thirsty or hot, inability to urinate
- Severe stomach pain with constipation
If any of these side effects occur while taking Vesicare you should contact your doctor immediately.
Contraindications for Toviaz and Vesicare?
Both Toviaz and Vesicare, like many medications for overactive bladder symptoms, may worsen certain urinary or gastric conditions. If you experience an increase in difficulty urinating, constipation, or severe abdominal pain after taking these drugs, you must seek immediate medical attention.
Neither Toviaz nor Vesicare should be used if you are currently taking or have recently been on medication known as potent CYP3A4 inhibitors (like ketoconazole). Always inform your physician of any medications that you are currently using; potent CYP3A4 inhibitors will require a period to clear from the system to avoid dangerous drug interactions with both Toviaz and Vesicare.
Additionally, patients with specific health issues such as uncontrolled narrow-angle glaucoma, slow gastric emptying (gastroparesis), or who suffer from urinary retention should not take either of these two medicines. As always when dealing with prescription medications like these two drugs it's important to provide your healthcare provider with a complete picture of your health history.
How much do Toviaz and Vesicare cost?
For the brand-name versions of these drugs:
- The price for 30 tablets of Toviaz (4 mg) averages around $390, which works out to approximately $13/day.
- The price for a similar quantity of Vesicare (5 mg) is about $420, costing roughly $14/day.
Hence, if you are in the typical dosage range for either drug – usually 4mg per day for Toviaz and 5mg per day for Vesicare – then brand-name Toviaz tends to be slightly less expensive on a per-day treatment basis. However, remember that cost should not be your primary consideration when choosing between these two medications.
As far as generic versions are concerned:
- Fesoterodine (generic name for Toviaz), at present does not have an available generic version in United States.
- Solifenacin succinate is the generic version of Vesicare and it costs significantly less than its branded counterpart. A package containing 30 tablets can range from $50-$80 depending upon pharmacy pricing which equates to about $1.6–$2.7/day based on a daily dose.
Popularity of Toviaz and Vesicare
Fesoterodine, in its generic form as well as in the brand name Toviaz, was estimated to have been prescribed to about 500,000 people in the US in 2020. Fesoterodine accounted for just over 10% of prescriptions for medications used to treat symptoms of an overactive bladder. However, it appears to be one of the most common "extended release" medications within this class - providing benefits throughout a full day with a single dose.
Solifenacin, including the branded version Vesicare, was prescribed to nearly 1 million people in America during that same period. In terms of overall prescriptions for urinary antispasmodics (drugs that reduce bladder contractions), solifenacin accounts for roughly 20%. This prevalence has remained relatively stable over the last decade. It's important to note both these drugs are similar and can effectively help manage symptoms such as frequent urination or urinary urgency but may cause different side effects which should be discussed with your healthcare provider.
Conclusion
Both Toviaz (fesoterodine) and Vesicare (solifenacin) have long-standing records of usage in patients with overactive bladder, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. Each of these drugs works by blocking the action of acetylcholine on muscarinic receptors, which helps to relax the detrusor muscle in the bladder wall, reducing urinary urgency, frequency, and incontinence.
Toviaz is usually considered as a first-line treatment option due to its higher selectivity for M3 receptors found predominantly in the bladder. Vesicare might be used if a patient doesn't respond well to Toviaz or has contraindications against it.
Both drugs are available in generic form which can offer significant cost savings especially for patients who must pay out-of-pocket. Both medications may require an adjustment period before their full effects become noticeable.
The side effect profile is similar between Toviaz and Vesicare; common ones include dry mouth, constipation, blurred vision and urinary retention. However, Toviaz seems less likely than Vesicare to cause dry mouth but may have a slightly higher risk of causing constipation. For both drugs, patients should seek medical help immediately if they experience difficulty urinating or severe abdominal pain.
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Refrences
- Chapple, C. R., Yamanishi, T., & Chess-Williams, R. (2002, November). Muscarinic receptor subtypes and management of the overactive bladder. Urology. Elsevier BV.http://doi.org/10.1016/s0090-4295(02)01803-4
- Michel, M. C., & De La Rosette, J. J. M. C. H. (2005, August 8). Role of muscarinic receptor antagonists in urgency and nocturia. BJU International. Wiley.http://doi.org/10.1111/j.1464-410x.2005.05651.x
- Tzefos, M., Dolder, C., & Olin, J. L. (2009, November 17). Formulary Forum: Fesoterodine for the Treatment of Overactive Bladder. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1345/aph.1m308
- Gupta, K., Kaur, K., Aulakh, B. S., & Kaushal, S. (2010, October). Fesoterodine for overactive bladder: A review of the literature. Current Therapeutic Research. Elsevier BV.http://doi.org/10.1016/j.curtheres.2010.10.003
- Shvarts, P. G., Vinarov, A. Z., Kadykov, A. S., Borodulina, I. V., Popov, S. V., & Kravchenko, M. A. (2014). Current pharmacotherapy of overactive bladder in neurological patients. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. Media Sphere Publishing Group.http://doi.org/10.17116/jnevro2014114121152-160
- Ercan, Ö., Köstü, B., Bakacak, M., Aytaç-Tohma, Y., Çoşkun, B., Avcı, F., & Efe, E. (2015, October). Comparison of solifenacin and fesoterodine in treatment of overactive bladder. Saudi Medical Journal. Saudi Medical Journal.http://doi.org/10.15537/smj.2015.10.12016
- Chapple, C. R., Van Kerrebroeck, P. E., Jünemann, K., Wang, J. T., & Brodsky, M. (2008, October 9). Comparison of fesoterodine and tolterodine in patients with overactive bladder. BJU International. Wiley.http://doi.org/10.1111/j.1464-410x.2008.07907.x