Adult Dosing
Ventricular arrhythmias
- 75 mg IV (over 5 hrs) q12 hrs
- Increase 75 mg/day q3 days
- Range: 75-150 mg q12 hrs
- Max: 600 mg/day in refractory cases
Atrial fibrillation/Flutter
- 112.5 mg IV (over 5 hrs) q12 hrs
- May increase if inadequate response and if QTc <500 ms , to 150 mg IV q12 hrs
- Max: 300 mg/day
Conversion from oral to IV sotalol
- 80 mg oral sotalol corresponds to 75 mg IV sotalol
- 120 mg oral sotalol corresponds to 112.5 mg IV sotalol
- 160 mg oral sotalol corresponds to 150 mg IV sotalol
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- > 60 mL/min: Use usual dose
- 40-60 mL/min: Use usual dose q12 hrs
- < 40 mL/min: Contraindicated
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
Note: No clinical experience with IV sotalol. The following adverse events listed below are attributed to oral form. Due to the similarity of exposure with intravenous sotalol and oral sotalol, the adverse reactions should be similar
- 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
- Initiate intravenous sotalol therapy in the presence of personnel trained in the management of serious ventricular arrhythmias
- 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 23 April 2010)
