PREPARATIONS: Tablets: 80, 120, 160, and 240 mg; oral solution: 5 mg/mL; injectable solution: 15 mg/mL
- Combining sotalol with beta-blockers such as atenolol (Tenormin), propranolol (Inderal), metoprolol (Lopressor), or calcium channel blockers such as verapamil (Calan, Isoptin, Verelan, Covera-HS) or diltiazem (Cardizem, Dilacor, Tiazac), may excessively slow heart rate or cause a block in the conduction of electrical impulses through the heart. Additionally, these combinations may further reduce blood pressure, possibly leading to hypotension.
- Digoxin and beta-blockers slow conduction of impulses in the heart and decrease heart rate. Combining them can increase the risk of slow heart rate.
- Sotalol may cause high blood glucose, and the dosage of insulin or antidiabetic drugs may require adjustment. It also may mask symptoms of low blood glucose (hypoglycemia).
- Administration of sotalol within 2 hours of antacids containing aluminum oxide and magnesium hydroxide may reduce blood concentrations of sotalol by 26%. This reduces the effect of sotalol. This combination should be avoided or the antacid should be taken two hours after the sotalol.
PREGNANCY AND BREASTFEEDING SAFETY: Sotalol crosses the placenta and is found in amniotic fluid. Safe use by pregnant women has not been established. Sotalol is excreted in human milk. A decision should be made whether to discontinue nursing or to discontinue the drug due to risk of adverse effects in the infant.
STORAGE: Store at room temperature, 15 C - 30 C (59 F - 86 F).
- For ventricular arrhythmias and supraventricular arrhythmias the recommended dose is 80 to 160 mg orally every 12 hours or 75 to 150 mg given intravenously every 12 hours.
- The recommended dose for refractory life-threatening ventricular arrhythmias is 80 to 160 mg orally every 12 hours. Doses of 160 to 640 mg/day given in divided doses every 8 to 12 hours may be required.
- The recommended dose for atrial fibrillation or flutter is 80 to 160 mg orally every 12 hours or 75 to 150 mg given intravenously every 12 hours.
- To reduce the risk of induced arrhythmia, patients should be observed for a minimum of 3 days in a facility that can provide cardiac resuscitation and continuous electrocardiographic monitoring while on their maintenance dose.
- The different formulations and brands of sotalol are not interchangeable.
DRUG CLASS AND MECHANISM:
- Sotalol is a beta-adrenergic blocking drug that is used to treat abnormal heart rhythms. Sotalol is a first generation beta blocker in a class that includes propranolol (Inderal, InnoPran), nadolol (Corgard), penbutolol sulfate (Levatol), timolol (Blocadren), and pindolol (Visken).
- These drugs differ from other beta blocking drugs because they are non-selective in nature, meaning that they block both beta-1 and beta-2 receptors on nerves and, therefore, will affect not only the heart but also the kidneys, lungs, gastrointestinal tract, liver, uterus, muscles surrounding blood vessels, and skeletal muscle.
- Norepinephrine and epinephrine (adrenaline) are chemicals released within the body that attach to receptors on several types of cells, including nerves and some muscles. Attachment changes the way the cells function, either stimulating the cells or suppressing them, in part through beta receptors.
- Sotalol prevents norepinephrine and epinephrine from binding to beta receptors on nerves. By blocking the effect of norepinephrine and epinephrine, beta blockers reduce heart rate, reduce the force of the heart's contractions, and reduce blood pressure by relaxing the muscles surrounding the blood vessels. Sotalol also directly reduces the rate at which the heart beats by reducing the rapidity of firing of the normal generator of electrical impulses in the heart (the heart's pacemaker).
- The FDA approved sotalol in October, 1992.
Reference: FDA Prescribing Information
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