Sotalol

Oral
Life-threatening ventricular arrhythmias

Oral
Supraventricular arrhythmias, Ventricular arrhythmias

CrCl (mL/min)	Dosage
<10	Not recommended.
10-30	Quarter the usual dose.
30-60	Half the usual dose.

Should be taken on an empty stomach. Take 1-2 hr before meals.

Bronchial asthma or history of COPD, sick sinus syndrome, symptomatic sinus bradycardia, cardiogenic shock. 2nd and 3rd degree AV block, untreated phaeochromocytoma, torsades de pointes, congenital or acquired long QT syndromes, uncontrolled cardiac failure, cardiogenic shock, metabolic acidosis, hypotension, severe peripheral arterial disease, Raynaud's disease, anaesth that causes myocardial depression. Renal impairment (CrCl <10 mL/min). Concomitant use w/ Ca channel blockers (e.g. verapamil and diltiazem).

Patients w/ well-compensated heart failure, myasthenia gravis, DM, 1st degree AV block. May mask symptoms of hyperthyroidism and hypoglycaemia. May worsen psoriasis. Patients undergoing major surgery requiring general anaesth. Avoid abrupt withdrawal as it may precipitate thyroid storm and exacerbate angina and MI. Renal impairment. Pregnancy and lactation.

Bradycardia, hypotension, chest pain, heart failure, dyspnoea, palpitations, oedema, ECG abnormalities, proarrhythmia, syncope, presyncope, rash, nausea/vomiting, dyspepsia, flatulence, diarrhoea, abdominal pain, cramps, fever, headache, fatigue, lightheadedness, dizziness, asthenia, sleep disturbances, mood changes, depression, paraesthesia, anxiety, sexual dysfunction, visual disturbances, taste abnormalities, hearing disturbances.
Potentially Fatal: Polymorphic ventricular tachycardia (very rare).

IV/Parenteral/PO: B

Monitor BP, heart rate, serum creatinine; Mg and K levels.

Symptoms: Bradycardia, CHF, hypotension, bronchospasm and hypoglycaemia. Management: Symptomatic and supportive treatment. Admin IV atropine, another anticholinergic drug, a β-adrenergic agonist or use transvenous cardiac pacing for bradycardia; transvenous cardiac pacemaker for heart block; epinephrine for hypotension; aminophylline or aerosol β₂-receptor stimulant for bronchospasm; and DC cardioverison, transvenous cardiac pacing, epinephrine, Mg sulfate for torsade de pointes. Removed via haemodialysis.

May increase risk of bradycardia w/ digoxin. May increase risk of arrhythmias w/ diuretics. May potentiate rebound HTN w/ clonidine. May prolong refractoriness w/ disopyramide, quinidine, procainamide, amiodarone and bepridil. May prolong QT interval w/ TCAs, phenothiazines, terfenadine and astemizole. Increased risk of torsades de pointes w/ K-depleting diuretics, erythromycin IV, halofantrine, pentamidine, and quinolones. May prolong neuromuscular blockade of tubocurarine. May reduce response to insulin and oral hypoglycaemics.
Potentially Fatal: Additive effect on AV conduction and ventricular function w/ verapamil and diltiazem.

Absorption may be reduced by food.

May falsely increase urinary metanephrine levels by photometric methods.

Description:
Mechanism of Action: Sotalol is a non-cardioselective β-blocker. It increases sinus cycle length, slows heart rate, decreases AV nodal conduction and increases AV nodal refractoriness. It also prolongs AV monophasic action potentials. However, it lacks intrinsic sympathomimetic and membrane-stabilising properties.
Onset: 1-2 hr (oral); approx 5-10 min (IV).
Duration: 8-16 hr.
Pharmacokinetics:
Absorption: Almost completely absorbed from the GI tract. Absorption may decrease by 20-30% w/ food. Bioavailability: 90-100% (oral). Time to peak plasma concentration: Approx 2-4 hr.
Distribution: Crosses placenta and blood brain barrier (small amounts); enters breast milk and CSF (small amounts). Plasma protein binding: Low.
Metabolism: Minimal metabolism.
Excretion: Via urine (as unchanged drug). Elimination half-life: 10-20 hr.

Store at 25°C.

Beta-Blockers

Anon. Sotalol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 29/11/2013.

Betapace AF (Bayer Healthcare Pharmaceuticals). U.S. FDA. https://www.fda.gov/. Accessed 29/11/2013.

Betapace and Betapace AF. U.S. FDA. https://www.fda.gov/. Accessed 29/11/2013.

Buckingham R (ed). Sotalol Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 29/11/2013.

Joint Formulary Committee. Sotalol Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 29/11/2013.

McEvoy GK, Snow EK, Miller J et al (eds). Sotalol Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 29/11/2013.

Sotacor Tab (Bristol-Myers Squibb). eMC. https://www.medicines.org.uk/emc/. Accessed 29/11/2013.