Sotalol

Indications
 Oral
Supraventricular and ventricular arrhythmias
Adult: Initially, 80 mg daily as a single or in 2 divided doses, increased gradually every 2-3 days. Usual dose: 160-320 mg daily in 2 divided doses. Max: 640 mg daily.
Child: Neonates: Initially, 1 mg/kg bid, increased every 3-4 days, if necessary. Max: 4 mg/kg bid. 1 mth-12 yr: Initially, 1 mg/kg bid, increased as necessary every 2-3 days. Max: 4 mg/kg bid, not exceeding 80 mg bid. For refractory supraventricular tachycardia, sotalol may be given with flecainide; <1 yr: 100-250 mg/m2 daily of sotalol and 40-150 mg/m2 daily of flecainide.
CrCl (ml/min)Dosage Recommendation
30-60Halve the usual dose.
10-30Quarter the usual dose.
<10Not recommended.

Oral
Life-threatening ventricular arrhythmias
Adult: 480-640 mg daily.
CrCl (ml/min)Dosage Recommendation
30-60Halve the usual dose.
10-30Quarter the usual dose.
<10Not recommended.

Intravenous
Acute arrhythmias
Adult: 20-120 mg (0.5-1.5 mg/kg) given by inj over 10 min, may repeat every 6 hr if needed. To substitute for oral treatment, 0.2-0.5 mg/kg/hr infusion may be used.
CrCl (ml/min)Dosage Recommendation
30-60Halve the usual dose.
10-30Quarter the usual dose.
<10Not recommended.

Intravenous
Programmed electrical stimulation (to test antiarrhythmic efficacy)
Adult: Initially, 1.5 mg/kg inj over 10-20 minutes, followed by of 0.2-0.5 mg/kg/hr infusion.
CrCl (ml/min)Dosage Recommendation
30-60Halve the usual dose.
10-30Quarter the usual dose.
<10Not recommended.


Special Populations: Renal impairment: CrCl 30-60 mL/min: ½ of the dose for both oral and IV route; 10-30 mL/min: ¼ of the dose for both oral and IV route.
Contraindications
 Bronchospasm, asthma, history of obstructive airways disease, sinus bradycardia, cardiogenic shock. 2nd and 3rd degree AV block, uncontrolled cardiac failure, metabolic acidosis, hypotension, severe peripheral arterial disease.
Warnings / Precautions
 Pregnancy and lactation. Renal insufficiency; preexisting sick sinus syndrome; compensated heart failure; gradual withdrawal is recommended. DM, 1st degree AV block. May mask the symptoms of hyperthyroidism and of hypoglycaemia. May unmask myasthenia gravis. May worsen psoriasis.
Adverse Reactions
 Nausea, sleep disorders, lassitude, diarrhoea, palpitations, bradycardia, weakness, dyspnoea, decreased sexual activity, impotence, extremity pain, back pain, asthma, visual disturbances, cardiac arrhythmias. Rebound angina, arrhythmias and MI if withdrawn abruptly.
Potentially Fatal: Polymorphic ventricular tachycardia (very rare). Rebound hypertension.
Overdose Reactions
 Rarely results in death.
Drug Interactions
 Decreased effect with antacids, calcium salts, NSAIDs, ampicillin, rifampicin. May reduce response to insulin and oral hypoglycaemics. May lead to enhanced hypotension when used with aldesleukin and general anaesthetics. Increased risk of bradycardia and heart block when used with calcium channel blockers and other cardiac depressants. May develop elevated BP when used with adrenaline. Reduced absorption when used with aluminium salts and bile-acid binding resins. Decreased metabolism when used with cimetidine, hydralazine, erythromycin and fluvoxamine.
Potentially Fatal: Rebound hypertension with clonidine and abrupt withdrawal of either drug. Polymorphic ventricular tachycardia with antidepressants and quinidine.
See Below for More sotalol Drug Interactions
Food Interactions
 Absorption may be reduced by food especially by milk.
Mechanism of Actions
 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. It is used in the treatment of ventricular arrhythmias.
Absorption: Almost completely absorbed from the GI tract (oral); peak plasma concentrations after 2-4 hr.
Distribution: Crosses the placenta and enters breast milk; crosses the blood-brain barrier and enters CSF (small amounts). Protein-binding: Low.
Metabolism: Minimal metabolism.
Excretion: Via urine (as unchanged). Elimination half-life: 10-20 hr.
Administration
 Should be taken on an empty stomach. (Take 1-2 hr before meals.)
Storage Conditions
 Intravenous: Store at 20-25°C. Oral: Store at 20-25°C.
ATC Classification
 C07AA07 - sotalol ; Belongs to the class of non-selective beta-blocking agents. Used in the treatment of cardiovascular diseases.
Storage
 Intravenous: Store at 20-25°C. Oral: Store at 20-25°C.
Available As
  • Sotalol 40 mg
  • Sotalol 80 mg

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