Adult Dosing
Ventricular arrhythmias (Sotalol, Betapace)
- Start 80 mg PO q12 hrs
- Increase dose q3 days
- Usual range: 120-160 mg q12 hrs
- MAX: 480-640 mg/day in refractory cases
Atrial fibrillation/Flutter (Sotalol AF, Betapace AF)
- Start 80 mg PO q12 hrs
- May be increased q3 days with careful monitoring (ECG and QT interval measurements 2-4 hrs after each dose) to 120 mg q12 hrs
- MAX: 320 mg/day
- Note: Initiate and titrate dose in a hospital with cardiac monitor
Pediatric Dosing
Atrial fibrillation/Flutter (Sotalol AF, Betapace AF)
- < 2 yrs: Dosage based on BSA and age-specific factor. Refer package insert
- > 2 yrs:
- Start 30 mg/m2 PO q8 hrs
- May increase q3 days to a maximum of 60 mg/m2 PO q8 hrs
- Max: 320 mg/day
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Sotalol, Betapace
- 30-59 mL/mim: Give dose q24 hrs
- 10-29 mL/mim: Give dose q36-48 hrs
- < 10 mL/min: Individualize dose
- Hemodialysis: Caution advised
- Increase dose after 5-6 doses at appropriate intervals
- Sotalol AF, Betapace AF
- 40-60 mL/min: 80 mg PO qd or 40 mg q12 hrs; monitor ECG and QT interval measurements 2-4 hr after each dose. If QT < 500 msec after 5-6 days, discharge patient. Max: 160 mg/day
- < 40 mL/min: contraindicated
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
- Sotalol can provoke new or worsened ventricular arrhythmias in some patients, including sustained ventricular tachycardia or ventricular fibrillation, with potentially fatal consequences. Due to the proarrhythmic effects of sotalol, its use in patients with less severe arrhythmias, even if the patients are symptomatic is not recommended
- It may cause excessive prolongation of the QT interval which may lead to serious arrhythmias
- Correct hypokalemia or hypomagnesemia before administering sotalol
- Anticipate proarrhythmic events with initial dose and with every upward dose adjustment
- Avoid treatment of patients with asymptomatic ventricular premature contractions
- Abrupt withdrawal may cause exacerbation of angina pectoris, arrhythmias and, in some cases, myocardial infarction.Gradually decrease dose over 1 to 2 wks
- Administer cautiously in patients with CHF controlled by digitalis and diuretics
- Drug may mask signs and symptoms of hypoglycemia (eg, tachycardia, BP changes). It may also potentiate insulin-induced hypoglycemia
- Use the smallest effective dose if treating patients with bronchospastic disease
- Make dose adjustments slowly, allowing 3 days between increments monitoring QT intervals and plasma levels
Cautions: Use cautiously in
- Renal impairment
- Peripheral vascular disease
- CHF
- Pheochromocytoma
- WPW syndrome
- Bronchospastic disease
- Diabetes mellitus
- Thyroid disorder
- Concurrent QT prolonging agents
- Electrolyte abnormalities
- Concurrent diuretics
- Major surgery
- Myasthenia gravis
Pregnancy Category:B
Breastfeeding: Sotalol is excreted into breastmilk extensively. Other beta-adrenergic blocking drugs are preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 22 April 2010 )
Pricing data from www.DrugStore.com in U.S.A.
- Betapace 80 MG TABS [Bottle] (BAYER HEALTHCARE PHARMA)
60 mg = $255.15
180 mg = $725.57 - Betapace AF 160 MG TABS [Bottle] (BAYER HEALTHCARE PHARMA)
60 mg = $420
180 mg = $1228.54 - Betapace 160 MG TABS [Bottle] (BAYER HEALTHCARE PHARMA)
30 mg = $214.18
90 mg = $621.52 - Betapace 240 MG TABS [Bottle] (BAYER HEALTHCARE PHARMA)
30 mg = $266
90 mg = $797.99 - Betapace AF 120 MG TABS [Bottle] (BAYER HEALTHCARE PHARMA)
60 mg = $304.46
180 mg = $877.77
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
