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Sotalol

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Sotalol, Betapace, Sotylize

  • Indications
  1. Ventricular Arrhythmia
  2. Atrial Fibrillation Cardioversion (or Atrial Flutter)
    1. Time to Cardioversion: 3-6 hours
    2. Conversion Rate: 20-52%
    3. Chronic Efficacy: 50-60%
  • Mechanism
  1. Class III Antiarrhythmic
    1. Prolongs Action Potential duration
    2. Prolongs cardiac tissue refractory period throughout heart Muscle
  2. Class II Antiarrhythmic
    1. Non-selective Beta Blocker
  • Precautions
  1. Proarrhythmic with risk of Torsades de Pointes
  2. Initiate in monitored setting capable of cardiac Resuscitation
  3. Monitoring
    1. Telemetry
    2. Renal Function (GFR)
  • Dosing
  1. Precautions
    1. Different formulations (Betapace, Betapace AF and Sotylize solution) are NOT equivalent
    2. Adjust dose in Renal Insufficiency
  2. Ventricular Arrhythmia (Betapace, Sotylize)
    1. Start 80 mg orally twice daily
    2. Target: 80-160 mg orally twice daily
    3. Maximum: 640 mg per day (Betapace), 320 mg/day (Sotylize)
  3. Atrial Fibrillation Rhythm Control (Betapace AF, Sotylize)
    1. Start 80 mg orally twice daily
    2. Target: 80-160 mg orally twice daily
    3. Maximum: 640 mg per day (Betapace AF), 160 mg/day (Sotylize)
  • Adverse Effects
  1. Hypotension
  2. Torsades de Pointes
    1. Associated with doses over 320 mg per day
    2. Higher risk in Congestive Heart Failure and female gender
  • Safety
  1. Pregnancy Category B
  2. Avoid in Lactation
  • Resources
  1. Sotalol (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=afce2787-8899-4098-87c8-f1e8dd19e6dd
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 78-9
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia