sotalol

ROUTE	ONSET	PEAK	DURATION
PO	hr	2–3 days	8–12 hr

Contraindicated in:

Hypersensitivity;
Asthma;
Cardiogenic shock or decompensated HF;
Congenital or acquired long QT syndrome;
Baseline QT interval >450 msec;
Sinus bradycardia, sick sinus syndrome, or 2nd- and 3rd-degree AV block (unless a functioning pacemaker is present);
Hypokalemia (↑ risk of arrhythmias);
CCr <40 mL/min (Betapace AF and Sotylize only);
Lactation: Lactation.

Use Cautiously in:

Renal impairment (↑ dosing interval);
Hepatic impairment;
Diabetes mellitus (may mask signs of hypoglycemia);
Thyrotoxicosis (may mask symptoms);
Patients with a history of severe allergic reactions (intensity of reactions may be ↑);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have ↑ sensitivity to beta blockers.

Adv. Reactions/Side Effects ⬆ ⬇

CV: ARRHYTHMIAS, BRADYCARDIA, HF, orthostatic hypotension

Derm: itching, rash

EENT: blurred vision, dry eyes, nasal stuffiness

Endo: hyperglycemia, hypoglycemia

GI: constipation, diarrhea, nausea

GU: erectile dysfunction, ↓libido

MS: arthralgia, back pain, muscle cramps

Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares, paresthesia

Resp: bronchospasm, PULMONARY EDEMA, wheezing

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with other class 1A antiarrhythmics is not recommended due to ↑ risk of arrhythmias.
General anesthesia, IV phenytoin, and verapamil may cause additive myocardial depression.
Additive bradycardia may occur with clonidine, digoxin, beta blockers, ivabradine, verapamil, and diltiazem.
Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates.
Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).
Concurrent thyroid hormone administration may ↓ effectiveness.
May alter the effectiveness of insulin or oral hypoglycemic agents.
May ↓ the effectiveness of beta-adrenergic bronchodilators and theophylline.
May ↓ the beneficial beta₁ cardiovascular effects of dopamine or dobutamine.
Discontinuation of clonidine in patients receiving sotalol may result in excessive rebound hypertension.
Use cautiously within 14 days of MAO inhibitors (may result in hypertension).

Route/Dosage ⬆ ⬇

Ventricular Arrhythmias

PO (Adults ): 80 mg twice daily; may gradually ↑ (usual maintenance dose is 160–320 mg/day in 2–3 divided doses; some patients may require up to 480–640 mg/day).

Renal Impairment

PO (Adults ): CCr 30–59 mL/min: initial dose of 80 mg, with subsequent doses given every 24 hr; CCr 10–29 mL/min: initial dose of 80 mg, with subsequent doses given every 36–48 hr.

Atrial Fibrillation/Atrial Flutter

PO (Adults ): 80 mg twice daily; may ↑ to 120 mg twice daily, if necessary.

Renal Impairment

PO (Adults ): CCr 40–60 mL/min: Administer every 24 hr.

Availability ⬆ ⬇

(Generic available)

Tablets : 80 mg; 120 mg; 160 mg; 240 mg
Tablets (Betapace AF): 80 mg; 120 mg; 160 mg
Oral solution (Sotylize) grape flavor: 5 mg/mL

Assessment ⬆ ⬇

Monitor ECG prior to and periodically during therapy. May cause life-threatening ventricular tachycardia associated with QT interval prolongation. Do not initiate sotalol therapy if baseline QTc is longer than 450 ms. If QT interval becomes ≥500 ms, reduce dose, prolong duration of infusion, or discontinue therapy.
Monitor BP and pulse frequently during dose adjustment period and periodically during therapy. Assess for orthostatic hypotension when assisting patient up from supine position.
Monitor intake and output ratios and daily weight. Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention).

Lab Test Considerations:

Calculate CCr prior to dosing.
- May cause ↑ BUN, serum potassium, triglyceride, and uric acid levels.
- May cause ↑ or ↓ in blood glucose levels.

Toxicity and Overdose:

Monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures). Notify health care professional immediately if these signs occur.
- Glucagon has been used to treat bradycardia and hypotension.

Implementation ⬆ ⬇

Do not confuse sotalol with Sudafed.
Patients should be hospitalized and monitored for arrhythmias for at least 3 days during initiation of therapy and dose increases.
- Do not substitute Betapace for Betapace AF. Make sure patients transferred from Betapace to Betapace AF have enough Betapace AF upon leaving the hospital to allow for uninterrupted therapy until Betapace AF prescription can be filled.
PO: Take apical pulse prior to administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify health care professional.
- Administer on an empty stomach, 1 hr before or 2 hr after meals. Administration with food, especially milk or milk products, reduces absorption by approximately 20%.
- Avoid administering antacids containing aluminum or magnesium within 2 hr of sotalol.
- For patients unable to swallow pills, pharmacist can convert tablets to a solution.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia. Advise patients taking Betapace AF to read the Medication Guide before starting and with each Rx refill in case of changes.
Advise patient to make sure enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency.
Caution patient to avoid taking antacids containing aluminum or magnesium within 2 hr of sotalol.
Teach patient and family how to check pulse and BP. Instruct them to check pulse daily and BP biweekly. Advise patient to hold dose and contact physician or other health care professional if pulse is <50 bpm or if BP changes significantly.
May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
Advise patients to change positions slowly to minimize orthostatic hypotension, especially during initiation of therapy or when dose is increased.
Caution patient that this medication may increase sensitivity to cold.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially cold preparations.
Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication may mask tachycardia and increased BP as signs of hypoglycemia, but dizziness and sweating may still occur.
Advise patient to notify health care professional immediately if new fast heartbeat with light-headedness and fainting occurs or if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding, bruising, or pain or swelling at the infusion site occurs.
Instruct patient to inform health care professional of medication regimen prior to treatment or surgery.
Rep: Advise females of reproductive potential to notify health care professional promptly if pregnancy is planned or suspected and to avoid breastfeeding during therapy. May cause growth restriction, transient fetal bradycardia, hyperbilirubinemia, hypoglycemia, uterine contractions, and possible intrauterine death in the exposed fetus. Monitor newborns exposed to sotalol for symptoms of beta blockade. May impair fertility by causing erectile dysfunction.
Advise patient to carry identification describing disease process and medication regimen at all times.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇