安斯泰来BPH药物VESOMNI获欧洲首个上市
安斯泰来（Astellas）欧洲子公司—Astellas Pharma Europe B.V 23日宣布，荷兰药品评价委员会（MEB）已批准了VESOMNI的上市许可申请（MAA），用于对单药疗法无足够响应的良性前列腺增生症（BPH）男性患者中度至重度储尿期症状（storage symptoms）及排尿期症状（voiding symptoms）的治疗。
荷兰将成为VESOMNI在未来整个欧洲相互认可程序（Mutual Recognition Procedures）的参考国。
VESOMNI是一种每日一次的薄膜包衣、双层修饰释放片剂，每片含6mg 抗胆碱索非那（antimuscarinic solifenacin）和0.4mg α1-肾上腺素能受体拮抗剂（α1-受体阻滞剂）坦洛新（tamsulosin）。
III期临床数据表明，与TOCAS相比，VESOMNI对45岁及以上BPH男性患者中度至重度储尿期症状和排尿期症状提供了具有统计学意义上的显着改善。此外，与安慰剂相比，VESOMNI在所有关键终点均表现出了统计学意义的显着改善。
III期临床中，最常见的不良事件为口干和便秘。

Vesomni 6 mg/0.4 mg modified release tablets
1. Name of the medicinal product
Vesomni 6 mg/0.4 mg modified release tablets
2. Qualitative and quantitative composition
Each tablet contains a layer of 6 mg solifenacin succinate, corresponding to 4.5 mg solifenacin free base and a layer of 0.4 mg tamsulosin hydrochloride, corresponding to 0.37 mg of tamsulosin free base.
For the full list of excipients, see section 6.1.
3. Pharmaceutical form
Modified release tablet
Each tablet is round, approximately 9 mm in diameter, red film-coated and debossed with “6/0.4”.
4. Clinical particulars
4.1 Therapeutic indications
Treatment of moderate to severe storage symptoms (urgency, increased micturition frequency) and voiding symptoms associated with benign prostatic hyperplasia (BPH) in men who are not adequately responding to treatment with monotherapy.
4.2 Posology and method of administration
Adult males, including older people
One Vesomni tablet (6 mg/0.4 mg) once daily taken orally with or without food. The maximum daily dose is one Vesomni tablet (6 mg/0.4 mg).
The tablet must be swallowed whole, intact without biting or chewing. Do not crush the tablet.
Patients with renal impairment
The effect of renal impairment on the pharmacokinetics of Vesomni has not been studied. However, the effect on the pharmacokinetics of the individual active substances is well known (see section 5.2). Vesomni can be used in 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 the maximum daily dose in these patients is one Vesomni tablet (6 mg/0.4 mg) (see section 4.4).
Patients with hepatic impairment
The effect of hepatic impairment on the pharmacokinetics of Vesomni has not been studied. However, the effect on the pharmacokinetics of the individual active substances is well known (see section 5.2). Vesomni can be used in patients with mild hepatic impairment (Child-Pugh score ≤ 7). Patients with moderate hepatic impairment (Child-Pugh score 7-9) should be treated with caution and the maximum daily dose in these patients is one Vesomni tablet (6 mg/0.4 mg). In patients with severe hepatic impairment (Child-Pugh score > 9), the use of Vesomni is contraindicated (see section 4.3).
Moderate and strong inhibitors of cytochrome P450 3A4
The maximum daily dose of Vesomni should be limited to one tablet (6 mg/0.4 mg). Vesomni should be used with caution in patients treated simultaneously with moderate or strong CYP3A4 inhibitors, e.g. verapamil, ketoconazole, ritonavir, nelfinavir, itraconazole (see section 4.5).
Paediatric population
There is no relevant indication for use of Vesomni in children and adolescents.
4.3 Contraindications
- Patients with hypersensitivity to the active substance(s) or to any of the excipients listed in section 6.1,
- Patients undergoing haemodialysis (see section 5.2),
- Patients with severe hepatic impairment (see section 5.2),
- Patients with severe renal impairment who are also treated with a strong cytochrome P450 (CYP) 3A4 inhibitor, e.g., ketoconazole (see section 4.5),
- Patients with moderate hepatic impairment who are also treated with a strong CYP3A4 inhibitor, e.g., ketoconazole (see section 4.5),
- Patients with severe gastrointestinal conditions (including toxic megacolon), myasthenia gravis or narrow-angle glaucoma and patients at risk for these conditions,
- Patients with a history of orthostatic hypotension.
4.4 Special warnings and precautions for use
Vesomni should be used with caution in patients with:
- severe renal impairment,
- risk of urinary retention,
- gastrointestinal obstructive disorders,
- risk of decreased gastrointestinal motility,
- hiatus hernia/gastroesophageal reflux and/or who are concurrently taking medicinal products (such as bisphosphonates) that can cause or exacerbate oesophagitis,
- autonomic neuropathy.
The patient should be examined in order to exclude the presence of other conditions, which can cause similar symptoms to benign prostatic hyperplasia.
Other causes of frequent urination (heart failure or renal disease) should be assessed before treatment with Vesomni is initiated. If a urinary tract infection is present, appropriate antibacterial therapy should be started.
QT prolongation and Torsade de Pointes have been observed in patients with risk factors, such as pre-existing long QT syndrome and hypokalaemia, who are treated with solifenacin succinate.
Angioedema with airway obstruction has been reported in some patients on solifenacin succinate and tamsulosin. If angioedema occurs, Vesomni should be discontinued and not restarted. Appropriate therapy and/or measures should be taken.
Anaphylactic reaction has been reported in some patients treated with solifenacin succinate. In patients who develop anaphylactic reactions, Vesomni should be discontinued and appropriate therapy and/or measures should be taken.
As with other alpha1-adrenoceptor antagonists, a reduction in blood pressure can occur in individual cases during treatment with tamsulosin, as a result of which, rarely, syncope can occur. Patients starting treatment with Vesomni should be cautioned to sit or lie down at the first signs of orthostatic hypotension (dizziness, weakness) until the symptoms have disappeared.
The 'Intraoperative Floppy Iris Syndrome' (IFIS, a variant of small pupil syndrome) has been observed during cataract and glaucoma surgery in some patients on or previously treated with tamsulosin hydrochloride. IFIS may increase the risk of eye complications during and after the operation. Therefore, the initiation of therapy with Vesomni in patients for whom cataract or glaucoma surgery is scheduled is not recommended. Discontinuing treatment with Vesomni 1-2 weeks prior to cataract or glaucoma surgery is anecdotally considered helpful, but the benefit of treatment discontinuation has not been established. During pre-operative assessment, surgeons and ophthalmic teams should consider whether patients scheduled for cataract or glaucoma surgery are being or have been treated with Vesomni in order to ensure that appropriate measures will be in place to manage IFIS during surgery.
Vesomni should be used with caution in combination with moderate and strong inhibitors of CYP3A4 (see section 4.5) and it should not be used in combination with strong inhibitors of CYP3A4, e.g., ketoconazole, in patients who are of the CYP2D6 poor metaboliser phenotype or who are using strong inhibitors of CYP2D6, e.g., paroxetine.
4.5 Interaction with other medicinal products and other forms of interaction
Concomitant medication with any medicinal products with anticholinergic properties may result in more pronounced therapeutic effects and undesirable effects. An interval of approximately one week should be allowed after stopping treatment with Vesomni, before commencing any anticholinergic therapy. The therapeutic effect of solifenacin may be reduced by concomitant administration of cholinergic receptor agonists.
Interactions with CYP3A4 and CYP2D6 inhibitors
Concomitant administration of solifenacin with ketoconazole (a strong inhibitor of CYP3A4) (200 mg/day) resulted in a 1.4- and 2.0-fold increase in Cmax and area under the curve (AUC) of solifenacin, while ketoconazole at a dose of 400 mg/day resulted in a 1.5- and 2.8-fold increase in Cmax and AUC of solifenacin.
Concomitant administration of tamsulosin with ketoconazole at a dose of 400 mg/day resulted in a 2.2- and 2.8-fold increase in Cmax and AUC of tamsulosin, respectively.
Since concomitant administration with strong inhibitors of CYP3A4, such as ketoconazole, ritonavir, nelfinavir and itraconazole may lead to increased exposure to both solifenacin and tamsulosin, Vesomni should be used with caution in combination with strong CYP3A4 inhibitors.
Vesomni should not be given together with strong CYP3A4 inhibitors in patients who are also CYP2D6 poor metaboliser phenotype or who are already using strong CYP2D6 inhibitors.
Concomitant administration of Vesomni with verapamil (a moderate CYP3A4 inhibitor) resulted in an approximately 2.2-fold increase in Cmax and AUC of tamsulosin and an approximately 1.6-fold increase in the Cmax and AUC of solifenacin. Vesomni should be used with caution in combination with moderate inhibitors of CYP3A4.
Concomitant administration of tamsulosin with the weak CYP3A4 inhibitor cimetidine (400 mg every 6 hours) resulted in a 1.44-fold increase in the AUC of tamsulosin, while Cmax was not significantly changed. Vesomni can be used with weak CYP3A4 inhibitors.
Concomitant administration of tamsulosin with the strong CYP2D6 inhibitor paroxetine (20 mg/day) resulted in an increase in Cmax and AUC of tamsulosin by 1.3- and 1.6-fold, respectively. Vesomni can be used with CYP2D6 inhibitors.
The effect of enzyme induction on the pharmacokinetics of solifenacin and tamsulosin has not been studied. Since solifenacin and tamsulosin are metabolised by CYP3A4, pharmacokinetic interactions are possible with CYP3A4 inducers (e.g., rifampicin) which may decrease the plasma concentration of solifenacin and tamsulosin.
Other Interactions
The following statements reflect the information available on the individual active substances.
Solifenacin
- Solifenacin can reduce the effect of medicinal products that stimulate the motility of the gastrointestinal tract, such as metoclopramide and cisapride.
- In vitro studies with solifenacin have demonstrated that at therapeutic concentrations, solifenacin does not inhibit CYP1A1/2, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1 or 3A4. Therefore, no interactions are expected between solifenacin and drugs metabolised by these CYP enzymes.
- Intake of solifenacin did not alter the pharmacokinetics of R-warfarin or S-warfarin or their effect on prothrombin time.
- Intake of solifenacin showed no effect on the pharmacokinetics of digoxin.
Tamsulosin
- Co-administration with other alpha1-adrenoceptor antagonists could lead to hypotensive effects.
- In vitro, the free fraction of tamsulosin in human plasma was not changed by diazepam, propranolol, trichlormethiazide, chlormadinone, amitriptyline, diclofenac, glibenclamide, simvastatin or warfarin. Tamsulosin does not change the free fraction of diazepam, propranolol, trichlormethiazide or chlormadinone. Diclofenac and warfarin, however, may increase the elimination rate of tamsulosin.
- Co-administration with furosemide causes a fall in plasma levels of tamsulosin, but as levels remain within the normal range, concurrent use is acceptable.
- In vitro studies with tamsulosin have demonstrated that at therapeutic concentrations, tamsulosin does not inhibit CYP1A2, 2C9, 2C19, 2D6, 2E1 or 3A4. Therefore, no interactions are expected between tamsulosin and drugs metabolised by these CYP enzymes.
- No interactions have been seen when tamsulosin was given concomitantly with atenolol, enalapril, or theophylline.
4.6 Fertility, pregnancy and lactation
Fertility
The effect of Vesomni on fertility has not been established. Animal studies with solifenacin or tamsulosin do not indicate harmful effects on fertility and early embryonic development (see section 5.3).
Ejaculation disorders have been observed in short and long term clinical studies with tamsulosin. Events of ejaculation disorder, retrograde ejaculation and ejaculation failure have been reported in the post authorization phase.
Pregnancy and lactation
Vesomni is not indicated for use in women.
4.7 Effects on ability to drive and use machines
No studies on the effects of Vesomni on the ability to drive or use machines have been performed. However, patients should be informed about the possible occurrence of dizziness, blurred vision, fatigue and uncommonly, somnolence, which may negatively affect the ability to drive or use machines (see section 4.8).
4.8 Undesirable effects
Summary of the safety profile
Vesomni may cause anticholinergic undesirable effects of, in general, mild to moderate severity. The most frequently reported adverse reactions during the clinical studies performed for the development of Vesomni were dry mouth (9.5%), followed by constipation (3.2%) and dyspepsia (including abdominal pain; 2.4%). Other common undesirable effects are dizziness (including vertigo; 1.4%), vision blurred (1.2%), fatigue (1.2%), and ejaculation disorder (including retrograde ejaculation; 1.5%). Acute urinary retention (0.3%, uncommon) is the most serious adverse drug reaction that has been observed during treatment with Vesomni in clinical studies.
Tabulated list of adverse reactions
In the table below the 'Vesomni frequency' column reflects adverse drug reactions that have been observed during the double-blind clinical studies performed for the development of Vesomni (based on reports of treatment-related adverse events, which have been reported by at least two patients and occurred with a frequency higher than for placebo in the double-blind studies).
The columns 'solifenacin frequency' and 'tamsulosin frequency' reflect adverse drug reactions (ADRs) previously reported with one of the individual components (as presented in the Summary of Product Characteristics (SmPCs) of solifenacin 5 and 10 mg and tamsulosin 0.4 mg respectively) that may also occur when receiving Vesomni (some of these have not been observed during the clinical development program of Vesomni).
The frequency of adverse reactions is defined as follows: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000), not known (cannot be estimated from the available data).

System Organ Class (SOC) /Preferred Term (PT)	ADR frequency observed during development of Vesomni	ADR frequency observed with the individual substances
		Solifenacin 5 mg and 10 mg#	Tamsulosin 0.4 mg#
Infections and infestations
Urinary tract infection		Uncommon
Cystitis		Uncommon
Immune system disorders
Anaphylactic reaction		Not known*
Metabolism and nutrition disorders
Decreased appetite		Not known*
Hyperkalaemia		Not known*
Psychiatric disorders
Hallucination		Very rare*
Confusional state		Very rare*
Delirium		Not known*
Nervous system disorders
Dizziness	Common	Rare*	Common
Somnolence		Uncommon
Dysgeusia		Uncommon
Headache		Rare*	Uncommon
Syncope			Rare
Eye disorders
Vision blurred	Common	Common	Not known*
Intraoperative Floppy Iris Syndrome (IFIS)			Not known**
Dry eyes		Uncommon
Glaucoma		Not known*
Visual impairment			Not known*
Cardiac disorders
Palpitations		Not known*	Uncommon
Torsade de Pointes		Not known*
Electrocardiogram QT prolongation		Not known*
Atrial fibrillation		Not known*	Not known*
Arrhythmia			Not known*
Tachycardia		Not known*	Not known*
Vascular disorders
Orthostatic hypotension			Uncommon
Respiratory, thoracic and mediastinal disorders
Rhinitis			Uncommon
Nasal dryness		Uncommon
Dyspnoea			Not known*
Dysphonia		Not known*
Epistaxis			Not known*
Gastrointestinal disorders
Dry mouth	Common	Very common
Dyspepsia	Common	Common
Constipation	Common	Common	Uncommon
Nausea		Common	Uncommon
Abdominal pain		Common
Gastro-oesophageal reflux disease		Uncommon
Diarrhea			Uncommon
Dry throat		Uncommon
Vomiting		Rare*	Uncommon
Colonic obstruction		Rare
Faecal impaction		Rare
Ileus		Not known*
Abdominal discomfort		Not known*
Hepatobiliary disorders
Liver disorder		Not known*
Liver function test abnormal		Not known*
Skin and subcutaneous tissue disorders
Pruritus	Uncommon	Rare*	Uncommon
Dry skin		Uncommon
Rash		Rare*	Uncommon
Urticaria		Very rare*	Uncommon
Angioedema		Very rare*	Rare
Stevens-Johnson syndrome			Very rare
Erythema multiforme		Very rare*	Not known*
Exfoliative dermatitis		Not known*	Not known*
Musculoskeletal and connective tissue disorders
Muscular weakness		Not known*
Renal and urinary disorders
Urinary retention***	Uncommon	Rare
Difficulty in micturition		Uncommon
Renal impairment		Not known*
Reproductive system and breast disorders
Ejaculation disorders including retrograde ejaculation and ejaculation failure	Common		Common
Priapism			Very rare
General disorders and administration site conditions
Fatigue	Common	Uncommon
Peripheral oedema		Uncommon
Asthenia			Uncommon

The ADRs from solifenacin and tamsulosin included in this table are the ADRs listed in the summary of product characteristics of both products.
from post-marketing reporting. Because these spontaneously reported events are from the worldwide post-marketing experience, the frequency of events and the role of solifenacin or tamsulosin and their causation cannot be reliably determined.
from post-marketing reporting, observed during cataract and glaucoma surgery.
see section 4.4 Special warnings and precautions for use.
Long –term safety of Vesomni
The profile of undesirable effects seen with treatment up to 1 year was similar to that observed in the 12-week studies. The product is well-tolerated and no specific adverse reactions have been associated with long-term use.
Description of selected adverse reactions
For urinary retention see section 4.4 Special warnings and precautions for use.
Older people
The therapeutic indication of Vesomni, moderate to severe storage symptoms (urgency, increased micturition frequency) and voiding symptoms associated with BPH, is a disease affecting elderly men. The clinical development of Vesomni has been performed in patients 45 to 91 years of age, with an average age of 65 years. Adverse reactions in the elderly population were similar to the younger population.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
4.9 Overdose
Symptoms
Overdosage with the combination of solifenacin and tamsulosin can potentially result in severe anticholinergic effects plus acute hypotension. The highest dose taken accidentally during a clinical study corresponded to 126 mg of solifenacin succinate and 5.6 mg of tamsulosin hydrochloride. This dose was well-tolerated, with mild dry mouth for 16 days as the only reported adverse event.
Treatment
In the event of overdose with solifenacin and tamsulosin, the patient should be treated with activated charcoal. Gastric lavage is useful if performed within 1 hour, but vomiting should not be induced.
As for other anticholinergics, symptoms of overdose due to the solifenacin component can be treated as follows:
- Severe central anticholinergic effects such as hallucinations or pronounced excitation: treat with physostigmine or carbachol.
- Convulsions or pronounced excitation: treat with benzodiazepines.
- Respiratory insufficiency: treat with artificial respiration.
- Tachycardia: treat symptomatically if needed. Beta-blockers should be used with caution, since the concomitant overdose with tamsulosin could potentially induce severe hypotension.
- Urinary retention: treat with catheterisation.
As with other antimuscarinics, in case of overdosing, specific attention should be paid to patients with a known risk for QT-prolongation (i.e., hypokalaemia, bradycardia and concurrent administration of medicinal products known to prolong QT-interval) and relevant pre-existing cardiac diseases (i.e., myocardial ischaemia, arrhythmia, congestive heart failure).
Acute hypotension, which can occur after overdosage due to the tamsulosin component, should be treated symptomatically. Hemodialysis is unlikely to be of help as tamsulosin is very highly bound to plasma proteins.
5. Pharmacological properties
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: alpha-adrenoceptor antagonists
ATC code: G04CA53
Mechanism of action
Vesomni is a fixed dose combination tablet containing two active substances, solifenacin and tamsulosin. These drugs have independent and complementary mechanisms of action in the treatment of lower urinary tract symptoms (LUTS) associated with BPH, with storage symptoms.
Solifenacin is a competitive and selective antagonist of muscarinic receptors and has no relevant affinity for various other receptors, enzymes and ion channels tested. Solifenacin has the highest affinity for muscarinic M3-receptors, followed by muscarinic M1- and M2-receptors.
Tamsulosin is an alpha1-adrenoceptor (AR) antagonist. It binds selectively and competitively to postsynaptic alpha1-ARs, in particular to subtypes alpha1A and alpha1D and is a potent antagonist in lower urinary tract tissues.
Pharmacodynamic effects
Vesomni tablets consist of two active substances with independent and complementary effects in LUTS associated with BPH, with storage symptoms:
Solifenacin ameliorates storage function problems related to non-neuronally released acetylcholine activating M3-receptors in the bladder. Non-neuronally released acetylcholine sensitizes urothelial sensory function and manifests as urinary urgency and frequency.
Tamsulosin improves voiding symptoms (increases the maximum urinary flow rate), by relieving obstruction via relaxation of smooth muscle in prostate, bladder neck and urethra. It also improves storage symptoms.
Clinical efficacy and safety
Efficacy was demonstrated in a pivotal phase 3 study in patients with LUTS associated with BPH with voiding (obstructive) symptoms and at least the following level of storage (irritative) symptoms: ≥ 8 micturitions/24 hours and ≥ 2 urgency episodes/24 hours.
Vesomni showed statistically significant improvements from baseline to end of study compared with placebo in the two primary endpoints, total International Prostate Symptom Score (IPSS) and Total Urgency and Frequency Score, and on the secondary endpoints urgency, micturition frequency, mean voided volume per micturition, nocturia, IPSS voiding sub-score, IPSS storage sub-score, IPSS quality of life (QoL), Overactive Bladder questionnaire (OAB-q) Bother score and OAB-q Health Related Quality of Life (HRQoL) score including all sub-scores (coping, concern, sleep and social).
Vesomni showed superior improvement compared with tamsulosin OCAS on Total Urgency and Frequency Score, as well as on micturition frequency, mean voided volume per micturition and IPSS storage sub-score. This was accompanied by significant improvements in IPSS QoL and OAB-Q HRQoL total score including all sub-scores. Furthermore, Vesomni was non-inferior to tamsulosin OCAS on total IPSS (p <0.001), as expected.
5.2 Pharmacokinetic properties
Vesomni
The information below presents the pharmacokinetic parameters after multiple dosing of Vesomni.
A multiple dose relative bioavailability study demonstrated that the administration of Vesomni results in comparable exposure to that of the co-administration of the separate tablets of solifenacin and tamsulosin OCAS of the same dose.
Absorption
After multiple dosing of Vesomni, the tmax of solifenacin varied between 4.27 hours and 4.76 hours in different studies; the tmax of tamsulosin varied between 3.47 hours and 5.65 hours. The corresponding Cmax values of solifenacin varied between 26.5 ng/mL and 32.0 ng/mL, while the Cmax of tamsulosin varied between 6.56 ng/mL and 13.3 ng/mL. The AUC values of solifenacin varied between 528 ng.h/mL and 601 ng.h/mL, and of tamsulosin between 97.1 ng.h/mL and 222 ng.h/mL. The absolute bioavailability of solifenacin is approximately 90%, while for tamsulosin 70% to 79% is estimated to be absorbed.
A single dose food effect study was performed with Vesomni dosed under fasted conditions, after a low fat, low caloric breakfast and after a high fat, high caloric breakfast. After a high fat, high caloric breakfast, a 54% increase in Cmax for the tamsulosin component of Vesomni was observed compared to the fasted state while the AUC increased by 33%. A low fat, low caloric breakfast did not affect the pharmacokinetics of tamsulosin. The pharmacokinetics of the solifenacin component were not affected by either a low fat, low caloric, or a high fat, high caloric breakfast.
Concomitant administration of solifenacin and tamsulosin OCAS resulted in a 1.19-fold increase in the Cmax and 1.24-fold increase in the AUC of tamsulosin as compared to the AUC of tamsulosin OCAS tablets administered alone. There was no indication of an effect of tamsulosin on the pharmacokinetics of solifenacin.
Elimination
After a single administration of Vesomni, the t1/2 of solifenacin ranged from 49.5 hours to 53.0 hours and of tamsulosin from 12.8 hours to 14.0 hours.
Multiple doses of verapamil 240 mg q.d. co-administered with Vesomni resulted in a 60% increase in Cmax and a 63% increase in AUC for solifenacin, while for tamsulosin Cmax increased by 115% and AUC by 122%. The changes in Cmax and AUC are not considered clinically relevant.
Population pharmacokinetic analysis of the phase 3 data showed that intra-subject variability in tamsulosin pharmacokinetics was related to differences in age, height and α1-acid glycoprotein plasma concentrations. An increase in age and α1-acid glycoprotein was associated with an increase in AUC, while an increase in height was associated with a decrease in AUC. The same factors resulted in similar changes in the pharmacokinetics of solifenacin. In addition, increases in gamma glutamyl transpeptidase were associated with higher AUC values. These changes in AUC are not considered clinically relevant.
Information from the individual active substances used as single entity products complete the pharmacokinetic properties of Vesomni:
Solifenacin
Absorption
For solifenacin tablets, tmax is independent of the dose and occurs 3 to 8 hours after multiple dosing. The Cmax and AUC increase in proportion to the dose between 5 to 40 mg. Absolute bioavailability is approximately 90%.
Distribution
The apparent volume of distribution of solifenacin following intravenous administration is approximately 600 L. Approximately 98% of solifenacin is bound to plasma proteins, primarily α1-acid glycoprotein.
Biotransformation
Solifenacin has a low first pass effect, being metabolised slowly. Solifenacin is extensively metabolised by the liver, primarily by CYP3A4. However, alternative metabolic pathways exist, that can contribute to the metabolism of solifenacin. The systemic clearance of solifenacin is about 9.5 L/h. After oral dosing, one pharmacologically active (4R-hydroxy solifenacin) and three inactive metabolites (N-glucuronide, N-oxide and 4R-hydroxyl-N-oxide of solifenacin) have been identified in plasma in addition to solifenacin.
Elimination
After a single administration of 10 mg [14C-labelled]-solifenacin, about 70% of the radioactivity was detected in urine and 23% in faeces over 26 days. In urine, approximately 11% of the radioactivity is recovered as unchanged active substance; about 18% as the N-oxide metabolite, 9% as the 4R-hydroxy-N-oxide metabolite and 8% as the 4R-hydroxy metabolite (active metabolite).
Tamsulosin
Absorption
For tamsulosin OCAS, tmax occurs 4 to 6 hours after multiple dosing of 0.4 mg/day. Cmax and AUC increase in proportion to the dose between 0.4 and 1.2 mg. The absolute bioavailability is estimated to be approximately 57%.
Distribution
The volume of distribution of tamsulosin following intravenous administration is about 16 L. Approximately 99% of tamsulosin is bound to plasma proteins, primarily α1-acid glycoprotein.
Biotransformation
Tamsulosin has a low first pass effect, being metabolised slowly. Tamsulosin is extensively metabolised by the liver, primarily by CYP3A4 and CYP2D6. The systemic clearance of tamsulosin is about 2.9 L/h. Most tamsulosin is present in plasma in the form of unchanged active substance.
None of the metabolites were more active than the original compound.
Elimination
After a single dose of 0.2 mg [14C-labelled]-tamsulosin, after 1 week about 76% of radioactivity is excreted in urine and 21% in faeces. In urine, approximately 9% of the radioactivity is recovered as unchanged tamsulosin; about 16% as the sulphate of o-deethylated tamsulosin, and 8% as o-ethoxyphenoxy acetic acid.
Characteristics in specific groups of patients
Older people
In the clinical pharmacology and biopharmaceutical studies, the age of the subjects varied between 19 and 79 years. After Vesomni administration, the highest mean exposure values were found in elderly subjects, although there was an almost complete overlap with individual values found in younger subjects. This was confirmed by population pharmacokinetic analysis of phase 2 and 3 data. Vesomni can be used in elderly patients.
Renal impairment
Vesomni
Vesomni can be used in patients with mild to moderate renal impairment, but should be used with caution in patients with severe renal impairment.
The pharmacokinetics of Vesomni have not been studied in patients with renal impairment.
The following statements reflect the information available on the individual components regarding renal impairment.
Solifenacin
The AUC and Cmax of solifenacin in patients with mild or moderate renal impairment were not significantly different from that found in healthy volunteers. In patients with severe renal impairment (creatinine clearance ≤ 30 mL/min), exposure to solifenacin was significantly greater than in the controls, with increases in Cmax of about 30%, AUC of more than 100% and t1/2 of more than 60%. A statistically significant relationship was observed between creatinine clearance and solifenacin clearance.
Pharmacokinetics in patients undergoing haemodialysis have not been studied.
Tamsulosin
The pharmacokinetics of tamsulosin have been compared in 6 subjects with mild to moderate (30 ≤ CrCl < 70 mL/min/1.73 m2) or severe (< 30 mL/min/1.73 m2) renal impairment and 6 healthy subjects (CrCl > 90 mL/min/1.73 m2). While a change in the overall plasma concentration of tamsulosin was observed as the result of altered binding to α1-acid glycoprotein, the unbound (active) concentration of tamsulosin hydrochloride, as well as the intrinsic clearance, remained relatively constant. Patients with end stage renal disease (CrCl < 10 mL/min/1.73 m2) have not been studied.
Hepatic impairment
Vesomni
Vesomni can be used in patients with mild to moderate hepatic impairment, but is contraindicated in patients with severe hepatic impairment.
The pharmacokinetics of Vesomni have not been studied in patients with hepatic impairment. The following statements reflect the information available on the individual components regarding hepatic impairment.
Solifenacin
In patients with moderate hepatic impairment (Child-Pugh score of 7 to 9) the Cmax was not affected, AUC increased by 60% and t½ doubled. The pharmacokinetics of solifenacin in patients with severe hepatic impairment have not been studied.
Tamsulosin
The pharmacokinetics of tamsulosin have been compared in 8 subjects with moderate hepatic impairment (Child-Pugh score of 7 to 9) and 8 healthy subjects. While a change in the overall plasma concentration of tamsulosin was observed as the result of altered binding to α1-acid glycoprotein, the unbound (active) concentration of tamsulosin did not change significantly with only a modest (32%) change in intrinsic clearance of unbound tamsulosin. Tamsulosin has not been studied in patients with severe hepatic impairment.
5.3 Preclinical safety data
Non-clinical studies have not been conducted with Vesomni. Solifenacin and tamsulosin have been extensively evaluated individually in animal toxicity tests and findings were consistent with the known pharmacological actions. Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, fertility, embryofetal development, genotoxicity, and carcinogenic potential and do not raise a concern for potentiation or synergism of adverse effects when solifenacin and tamsulosin are combined.
6. Pharmaceutical particulars
6.1 List of excipients
Mannitol (E421)
Maltose
Macrogol 7.000.000
Macrogol 8000
Magnesium stearate (E470b)
Butylhydroxytoluene (E321)
Colloidal silica anhydrous (E551)
Hypromellose (E464)
Iron oxide red (E172)
6.2 Incompatibilities
Not applicable.
6.3 Shelf life
3 years.
6.4 Special precautions for storage
The medicinal product does not require any special storage conditions.
6.5 Nature and contents of container
Aluminium blister packs containing 10, 14, 20, 28, 30, 50, 56, 60, 90, 100 or 200 tablets.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal and other handling
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
7. Marketing authorisation holder
Astellas Pharma Ltd.
2000 Hillswood Drive
Chertsey
Surrey
KT16 0RS
United Kingdom
8. Marketing authorisation number(s)
PL 00166/0404
9. Date of first authorisation/renewal of the authorisation
Date of first authorisation: 23/10/2013
10. Date of revision of the text
23/10/2013
New Drugs Online Report for solifenacin + tamsulosin
Information
Generic Name: solifenacin + tamsulosin  
Trade Name: Vesomni 
Synonym: EC905 
Entry Type: New formulation  
Developmental Status
UK: Launched 
EU: Launched 
US: None 
UK launch Plans: Available only to registered users
Actual UK launch date: February 2014 
Comments
Feb 14: Launched in the UK for treatment of men with lower urinary tract symptoms. Net price: £27.62 for 30 x 6mg/0.4mg tabs [7].
03/02/2014 11:45:13 
Nov 13: Launched in the Netherlands for the treatment of moderate to severe storage symptoms (urgency and increased micturition frequency) and voiding symptoms associated with BPH, in patients not responding adequately to monotherapy [6].
06/12/2013 17:52:19 
May 13: Approved in the EU [6].
06/12/2013 17:50:43 
Mar 12: Filed in the Netherlands via the EU decentralised procedure [3].
28/03/2012 15:45:23 
PIII in the EU [1].
07/03/2011 14:36:09 
Trial or other data
Mar 13: NCT01018511 was completed in March 2011 [5]. 
08/03/2013 16:01:23
NEPTUNE II is a PIII open-label extension study (NCT01021332) investigating long-term efficacy & safety of the solifenacin/tamsulosin oral controlled absorption system (OCAS) over 52 weeks. The study will recruit 800 pts & will complete in May 11. The primary outcome measures include incidence & severity of AEs; secondary outcome measures are change from baseline to endpoint in data from micturition diary, & I-PSS questionnaire [2].
02/03/2011 10:38:56
The PIII NEPTUNE (NCT01018511) study is examining the efficacy, safety & tolerability of combination therapy of tamsulosin and solifenacin compared to monotherapy of tamsulosin in the treatment of males with LUTS associated with BPH with a substantial storage component. Two fixed dose combinations of 6mg and 9mg solifanacin with 400micrograms tamsulosin will be studied over 12 weeks a& the primary outcome is change from baseline to endpoint in total International Prostate Symptom Score. 1,713 patients will be enrolled at sites in the UK, Austria, Belarus, Belgium, Czech Republic, France, Germany, Hungary, Italy, Poland, Russia & Slovakia. The study is expected to complete in Feb 11 [2]. 
02/03/2011 10:32:49
Evidence Based Evaluations
EPAR  http://db.cbg-meb.nl/Pars/h111622.pdf 
SMC  
References  
Available only to registered users
 Category
BNF Category: Drugs for urinary retention (07.04.01)
Pharmacology: Antimuscarinic agent & alpha-blocker combination  
Epidemiology: BPH affects the quality of life of about a third of men over 50 years, the numbers increasing markedly with years. Histological evidence of BPH occurs in up to 90% of men by the age of 80. [4]  
Indication: Benign prostatic hyperplasia 
Additional Details:  
Method(s) of Administration  
Oral 
Company Information
Name: Astellas 
US Name: Astellas 
NICE Information
Anticipated Commissioning route (England) - 
In timetable: -