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Sotalol: Drug information

Sotalol: Drug information
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ALERT: US Boxed Warning
Life-threatening proarrhythmia:

To minimize the risk of drug-induced arrhythmia, initiate, reinitiate, or uptitrate sotalol in a facility that can provide cardiac resuscitation and continuous ECG monitoring. Sotalol can cause life threatening ventricular tachycardia associated with QT interval prolongation. Do not initiate sotalol therapy if the baseline QTc is longer than 450 msec. If the QT interval prolongs to 500 msec or greater, reduce the dose, lengthen the dosing interval, or discontinue the drug. Calculate CrCl to determine appropriate dosing.

Brand Names: US
  • Betapace;
  • Betapace AF;
  • Sorine [DSC];
  • Sotylize
Brand Names: Canada
  • APO-Sotalol;
  • DOM-Sotalol [DSC];
  • JAMP-Sotalol;
  • MED Sotalol;
  • PMS-Sotalol;
  • RATIO-Sotalol;
  • RIVA-Sotalol [DSC]
Pharmacologic Category
  • Antiarrhythmic Agent, Class II;
  • Antiarrhythmic Agent, Class III;
  • Beta-Blocker, Nonselective
Dosing: Adult

Note: Baseline QTc interval and CrCl must be determined prior to initiation. If CrCl ≤60 mL/minute, dosing interval adjustment is necessary. When initiating sotalol, patients should be hospitalized for at least 3 days in order to monitor cardiac rhythm and assess for QT prolongation. Maintain potassium and magnesium in the normal range prior to initiation and during therapy. Proarrhythmic events can occur after initiation of therapy and with each upward dosage adjustment.

Atrial fibrillation/flutter, maintenance of sinus rhythm

Atrial fibrillation/flutter, maintenance of sinus rhythm:

Maintenance dose:

Oral:

Initial: 80 mg twice daily.

Dose adjustment: If initial dose does not reduce frequency of relapse and excessive QTc prolongation does not occur (eg, QTc <500 msec) after 3 days, may increase dose to 120 mg twice daily; may increase dose further after another 3 days to a maximum dose of 160 mg twice daily if response is inadequate and QTc prolongation is not excessive (eg, QTc <500 msec).

IV (as substitution for oral sotalol):

Initial dose: 75 mg infused over 5 hours twice daily.

Dose adjustment: If initial dose does not reduce frequency of relapse and excessive QTc prolongation does not occur (eg, QTc <500 msec) after 3 days, may increase dose to 112.5 mg twice daily; may increase dose further after another 3 days to a maximum dose of 150 mg twice daily if response is inadequate and QTc prolongation is not excessive (eg, QTc < 500 msec).

Loading dose to initiate therapy or for dose escalation: Not routinely required. This approach consists of a single, initial IV dose administered over 1 hour, followed by oral maintenance dosing beginning 4 to 12 hours later (see table). The IV loading dose is used to quickly achieve maximum steady-state concentrations similar to the targeted oral maintenance dose in order to observe how patients respond in a setting with continuous ECG monitoring. Achieving maximum steady-state concentrations quickly with an IV loading dose may help facilitate faster patient discharge (Ref):

Note: Dosing derived from pharmacokinetic/pharmacodynamic modeling in 15 healthy volunteers (Ref).

Sotalol IV Loading Dose or Dose Escalation

CrCl (mL/minute)a

Therapy initiationb: IV loading dose (mg) when oral maintenance is planned to be:

Therapy escalationb: IV loading dose (mg) when increasing the oral maintenance dose from:

Minimum delay to start of oral dose (hour)

Oral dosing interval (hour)

80 mgc

120 mg

80 to 120 mg

120 to 160 mg

a Calculate using Cockcroft-Gault formula.

b Monitor QTc interval every 15 minutes during the 1-hour infusion and around the Tmax (2 to 4 hours post dose) of oral doses given within the first 24 hours of therapy. If QTc interval prolongs to >500 msec or increases ≥20% from baseline, discontinue sotalol when targeting an oral maintenance dose of 80 mg. When targeting an oral maintenance dose of 120 mg, discontinue sotalol and consider reinitiating to target 80 mg; when reinitiating to target 80 mg, wait at least 1 day in patients with CrCl ≥60 mL/minute (Somberg 2020; manufacturer’s labeling).

c Recommended starting dose.

>90 mL/minute

60 mg

90 mg

75 mg

90 mg

4 hours

12 hours

60 to 90 mL/minute

82.5 mg

125 mg

82.5 mg

105 mg

4 hours

12 hours

Fetal tachycardia, sustained

Fetal tachycardia, sustained (maternal/transplacental administration) (off-label use): Oral: Initial: 80 to 160 mg twice daily; may increase dose as needed up to 480 mg/day in 2 to 3 divided doses based on response and tolerability (Ref).

Supraventricular tachycardia

Supraventricular tachycardia (off-label use): Oral: Initial: 40 to 80 mg every 12 hours; maximum maintenance dose: 160 mg every 12 hours (Ref).

Ventricular arrhythmias

Ventricular arrhythmias:

Maintenance dose:

Oral:

Initial dose: 80 mg twice daily.

Dose adjustment: If initial dose does not reduce frequency of relapse and excessive QTc prolongation does not occur (eg, QTc <500 msec) after 3 days, may increase dose to 120 mg twice daily; may increase dose further after another 3 days to a usual maximum dose of 160 mg twice daily if response is inadequate and QTc prolongation is not excessive (eg, QTc <500 msec).

IV (as substitution for oral sotalol):

Initial dose: 75 mg infused over 5 hours twice daily.

Dose adjustment: If initial dose does not reduce frequency of relapse and excessive QTc prolongation does not occur (eg, QTc <500 msec) after 3 days, may increase dose to 112.5 mg twice daily; may increase dose further after another 3 days to a usual maximum dose of 150 mg twice daily if response is inadequate and QTc prolongation is not excessive (eg, QTc <500 msec).

Loading dose to initiate therapy or for dose escalation: Not routinely required. This approach consists of a single, initial IV dose administered over 1 hour, followed by oral maintenance dosing beginning 4 to 12 hours later (see table). The IV loading dose is used to quickly achieve maximum steady-state concentrations similar to the targeted oral maintenance dose in order to observe how patients respond in a setting with continuous ECG monitoring. Achieving maximum steady-state concentrations quickly with an IV loading dose may help facilitate faster patient discharge (Ref):

Note: Dosing derived from pharmacokinetic/pharmacodynamic modeling in 15 healthy volunteers (Ref).

Sotalol IV Loading Dose or Dose Escalation

CrCl (mL/minute)a

Therapy initiationb: IV loading dose (mg) when oral maintenance is planned to be:

Therapy escalationb: IV loading dose (mg) when increasing the oral maintenance dose from:

Minimum delay to start of oral dose (hour)

Oral dosing interval (hour)

80 mgc

120 mg

80 to 120 mg

120 to 160 mg

a Calculate using Cockcroft-Gault formula.

b Monitor QTc interval every 15 minutes during the 1-hour infusion and around the Tmax (2 to 4 hours post dose) of oral doses given within the first 24 hours of therapy. If QTc interval prolongs to >500 msec or increases ≥20% from baseline, discontinue sotalol when targeting an oral maintenance dose of 80 mg. When targeting an oral maintenance dose of 120 mg, discontinue sotalol and consider reinitiating to target 80 mg; when reinitiating to target 80 mg, wait at least 1 day in patients with CrCl ≥60 mL/minute.

c Recommended starting dose.

>90 mL/minute

60 mg

90 mg

75 mg

90 mg

4 hours

12 hours

60 to 90 mL/minute

82.5 mg

125 mg

82.5 mg

105 mg

4 hours

12 hours

Sustained monomorphic ventricular tachycardia, hemodynamically stable (off-label use): IV: 1.5 mg/kg or 100 mg over 5 minutes (Ref).

Ventricular premature beats, symptomatic (off-label use): Oral: Initial: 80 mg twice daily; dose may be increased gradually in increments of 80 mg/day up to a maximum dose of 160 mg twice daily; allow 3 days between dose adjustments in order to attain steady-state plasma concentrations and to allow for monitoring of QT intervals (Ref).

Conversion from oral sotalol to IV sotalol:

Note: Conversion only applies when substituting an oral maintenance dose with an IV dose administered as a 5-hour infusion.

80 mg oral equivalent to 75 mg IV.

120 mg oral equivalent to 112.5 mg IV.

160 mg oral equivalent to 150 mg IV.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function:

Maintenance dose:

Atrial fibrillation/flutter: Oral, IV:

CrCl >60 mL/minute: Administer every 12 hours.

CrCl 40 to 60 mL/minute: Administer every 24 hours.

CrCl <40 mL/minute: Use is contraindicated.

Ventricular arrhythmia: Oral, IV:

CrCl >60 mL/minute: Administer every 12 hours.

CrCl 30 to 60 mL/minute: Administer every 24 hours.

CrCl 10 to 29 mL/minute: Administer every 36 to 48 hours.

CrCl <10 mL/minute: Avoid use (Ref).

Loading dose to initiate therapy or for dose escalation: Atrial fibrillation/flutter or ventricular arrhythmia: IV: Not routinely required. This approach consists of a single, initial IV dose administered over 1 hour, followed by oral maintenance dosing beginning 4 to 12 hours later depending on kidney function (see table). The IV loading dose is used to quickly achieve maximum steady-state concentrations similar to the targeted oral maintenance dose in order to observe how patients respond in a setting with continuous ECG monitoring. Achieving maximum steady-state concentrations quickly with an IV loading dose may help facilitate faster patient discharge (Ref):

Note: Dosing derived from pharmacokinetic/pharmacodynamic modeling in 15 healthy volunteers. Doses for CrCl <40 mL/minute only apply to patients with ventricular arrhythmias since use of oral therapy is contraindicated in patients with atrial fibrillation/flutter and CrCl <40 mL/minute. Patients with kidney dysfunction will require a higher initial IV dose to test safety and efficacy of the oral sotalol regimen because these patients tend to have higher sotalol concentrations at steady state despite proper dosage adjustments (Ref).

Sotalol IV Loading Dose or Dose Escalation

CrCl (mL/minute)a

Therapy initiationb: IV loading dose (mg) when oral maintenance is planned to be:

Therapy escalationb: IV loading dose (mg) when increasing the oral maintenance dose from:

Minimum delay to start of oral dose (hour)

Oral dosing interval (hour)

80 mgc

120 mg

80 to 120 mg

120 to 160 mg

a Calculate using Cockcroft-Gault formula.

b Monitor QTc interval every 15 minutes during the 1-hour infusion and around the Tmax (2 to 4 hours post dose) of oral doses given within the first 24 hours of therapy. If QTc interval prolongs to >500 msec or increases ≥20% from baseline, discontinue sotalol when targeting an oral maintenance dose of 80 mg. When targeting an oral maintenance dose of 120 mg, discontinue sotalol and consider reinitiating to target 80 mg; when reinitiating to target 80 mg, wait at least 1 day in patients with CrCl ≥60 mL/minute, at least 3 days in patients with CrCl 30 to <60 mL/minute, and at least 7 days in patients with CrCl 10 to <30 mL/minute (manufacturer’s labeling).

c Recommended starting dose.

>90 mL/minute

60 mg

90 mg

75 mg

90 mg

4 hours

12 hours

60 to 90 mL/minute

82.5 mg

125 mg

82.5 mg

105 mg

4 hours

12 hours

30 to <60 mL/minute

75 mg

112.5 mg

82.5 mg

105 mg

6 hours

24 hours

10 to <30 mL/minute

75 mg

112.5 mg

82.5 mg

105 mg

12 hours

48 hours

Hemodialysis , intermittent (thrice weekly): Dialyzable (20% to 43%) (Ref): Oral, IV:

Avoid use; consider alternative agent (Ref). Multiple cases of torsades de pointes have been reported when sotalol was used, even at low dosages (eg, 80 mg daily orally) in patients with end-stage kidney disease treated with hemodialysis (Ref). In at least one case, QT interval was not corrected by several days of dialysis, suggestive of widely fluctuating and unpredictable tissue and plasma drug concentrations (Ref).

Peritoneal dialysis: Oral, IV: Avoid use; consider alternative agent (Ref). Cases of torsades de pointes have been reported when sotalol was used even at low dosages (eg, 80 mg daily orally) in patients with end-stage kidney disease treated with peritoneal dialysis (Ref).

CRRT:

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted.

Oral, IV: Avoid use; consider alternative agent(s), as no pharmacokinetic data are available in this population. Additionally, removal by CRRT can be interrupted by clotting, filter changes, etc. (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration):

Oral, IV: Avoid use, consider alternative agent(s), as no pharmacokinetic data are available in the population. Additionally, clearance will vary on PIRRT versus non-PIRRT days (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely because sotalol is not metabolized by the liver.

Dosing: Adjustment for Toxicity: Adult

QTc ≥500 msec:

Tablets, oral solution: Reduce dose, prolong the dosing interval, or discontinue sotalol

Injection:

Substitution for oral: Reduce dose, prolong the infusion time by decreasing the infusion rate, prolong the dosing interval, or discontinue sotalol.

Loading dose to initiate therapy or for dose escalation: Refer to table in adult or renal dosing sections.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

Dosage guidance:

Safety: Baseline QTc interval and CrCl must be determined prior to initiation; use with caution if QTc is >500 msec. Measure baseline serum potassium and magnesium; normalize prior to initiating therapy. Dosage must be adjusted to individual response and tolerance; doses should be initiated and preferably increased in a hospital facility that can provide continuous ECG monitoring and cardiac resuscitation.

Dosing: In pediatric patients, dosing may be based on either BSA (mg/m2) or weight (mg/kg); use extra caution to verify dosing parameters during calculations.

Clinical considerations: For infants and children ≤2 years of age, the manufacturer recommends a dosage reduction based on an age factor determined from an age factor nomogram.

Arrhythmias, treatment

Arrhythmias, treatment (eg, ventricular arrhythmias, atrial fibrillation, atrial flutter, supraventricular tachycardia, junctional ectopic tachycardia):

Oral:

BSA-directed dosing:

Infants and Children ≤2 years: The manufacturer-recommended pediatric dosage of 30 mg/m2/dose every 8 hours must be REDUCED using an age-related factor that is obtained from the graph (see graph). First, obtain the patient's age in months; use the graph to determine where the patient's age (on the logarithmic scale) intersects the age factor curve; read the age factor from the Y-axis; then multiply the age factor by the pediatric dose of 30 mg/m2/dose; this will result in the proper reduction in dose for age. For example, the age factor for an infant 2 months of age is 0.8, so the initial dose would be (0.8 × 30 mg/m2/dose) = 24 mg/m2/dose given every 8 hours. Increase dosage gradually as needed; allow adequate time between dosage increases to achieve new steady-state plasma concentration and to monitor clinical response, heart rate, and QTc interval; half-life is prolonged with decreasing age (<2 years), so time to reach new steady-state plasma concentration is increased (Ref). Refer to manufacturer's labeling for more information.

Sotalol age factor nomogram for patients 2 years of age and older

Children >2 years and Adolescents: Initial: 30 mg/m2/dose given every 8 hours; increase dosage gradually if needed; allow at least 36 hours between dosage increases to achieve new steady-state plasma concentration and to monitor clinical response, heart rate, and QTc intervals; may increase gradually to a maximum of 60 mg/m2/dose given every 8 hours; not to exceed adult doses (usual maximum adult daily dose: 320 mg/day) (Ref).

Weight-directed dosing:

Infants and Children ≤2 years: The manufacturer-recommended pediatric dosage of 1.2 mg/kg/dose every 8 hours must be REDUCED using an age-related factor that is obtained from the graph (see graph). First, obtain the patient's age in months; use the graph to determine where the patient's age (on the logarithmic scale) intersects the age factor curve; read the age factor from the Y-axis; then multiply the age factor by the pediatric dose of 1.2 mg/kg/dose; this will result in the proper reduction in dose for age. For example, the age factor for an infant 2 months of age is 0.8, so the initial dose would be (0.8 × 1.2 mg/kg/dose) = 0.96 mg/kg/dose given every 8 hours. Increase dosage gradually as needed; allow adequate time between dosage increases to achieve new steady-state plasma concentration and to monitor clinical response, heart rate, and QTc interval; half-life is prolonged with decreasing age (<2 years), so time to reach new steady-state plasma concentration is increased (Ref). Refer to manufacturer's labeling for more information.

Sotalol age factor nomogram for patients 2 years of age and older

Children >2 years and Adolescents: Initial: Oral: 0.67 to 1.2 mg/kg/dose every 8 hours; increase dose based on clinical response, heart rate, and QTc interval, allow 36 hours between dosage increases to achieve steady-state plasma concentration, maximum daily dose: 8 mg/kg/day, not to exceed adult doses (usual maximum adult daily dose: 320 mg/day) (Ref).

IV: Note: May be used in place of oral sotalol in patients unable to take oral medications or to achieve steady-state plasma concentration faster.

Loading dose (acute treatment):

BSA-directed dosing:

Infants, Children, and Adolescents: IV: 30 to 40 mg/m2/dose over 15 to 60 minutes, maximum dose: 80 mg/dose (Ref).

Weight-directed dosing:

Infants, Children, and Adolescents: Usual reported dose: 1 mg/kg/dose over 30 to 60 minutes, maximum dose: 80 mg/dose (Ref).

The manufacturer recommends loading dose based on age:

Infants and Children <6 years: IV: Initial: 1.2 mg/kg/dose over 60 minutes.

Children ≥6 years: IV: Initial: 1.1 mg/kg/dose over 60 minutes.

Adolescents: IV: Initial: 0.95 mg/kg/dose over 60 minutes.

Maintenance dose (eg, unable to take oral medications): Very limited data available; reported regimens variable and ideal dose response not established:

BSA-directed dosing:

Infants, Children, and Adolescents: IV: 50 mg/m2/day divided every 8 to 12 hours (Ref), maximum dose: 80 mg/dose; administer each dose over 2 to 5 hours (Ref).

Weight-directed dosing:

Infants, Children, and Adolescents: IV: 3 mg/kg/day divided every 8 to 12 hours (Ref), maximum dose: 80 mg/dose, administer each dose over 2 to 5 hours (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing adjustment for toxicity:

Infants, Children, and Adolescents:

QTc ≥500 msec:

Oral: Reduce dose, increase dosing interval, or discontinue sotalol.

IV: Reduce dose or discontinue sotalol.

Dosing: Kidney Impairment: Pediatric

Altered kidney function:

Infants, Children, and Adolescents:

Oral: There are no pediatric-specific dosage adjustments provided in manufacturer's labeling; dosing in children with kidney impairment has not been studied. In adults, a lower dose or increased dosing interval is recommended; closely monitor clinical response, heart rate, and QTc interval; allow adequate time between dosage increases to achieve new steady-state plasma concentration, since half-life will be prolonged with kidney impairment.

IV: Initiate at a lower dose and increase dose less frequently; allow adequate time between dosage increases to achieve new steady-state plasma concentration, since half-life will be prolonged. Closely monitor clinical response, heart rate, and QTc interval.

Hemodialysis: IV, Oral: Hemodialysis would be expected to reduce sotalol plasma concentrations because sotalol is not bound to plasma proteins and does not undergo extensive metabolism. According to the manufacturers, extreme caution should be employed if sotalol is used in patients with kidney failure undergoing hemodialysis. In adults, multiple cases of torsades de pointes have been reported when sotalol was used even at low adult dosages (eg, 80 mg daily) in patients with end-stage kidney disease treated with hemodialysis (Ref).

Peritoneal dialysis: IV, Oral: There are no pediatric-specific dosage adjustments provided in manufacturer's labeling. Peritoneal dialysis does not remove sotalol; in adults, supplemental dose is not necessary (Ref). Cases of torsades de pointes have been reported when sotalol was used even at low adult dosages (eg, 80 mg daily) in patients with end-stage kidney disease treated with peritoneal dialysis (Ref).

Dosing: Liver Impairment: Pediatric

All patients: There are no dosage adjustments provided in the manufacturer's labeling; however, clearance is not affected by liver impairment.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. There is minimal clinical experience with IV sotalol; however, since exposure is similar between IV and oral sotalol, adverse reactions are expected to be similar.

>10%:

Cardiovascular: Bradycardia (dose related; 8% to 13%), chest pain (8%), palpitations (8%)

Nervous system: Dizziness (13% to 16%), fatigue (dose related; 19% to 26%), headache (12%)

Neuromuscular & skeletal: Asthenia (5% to 11%)

Respiratory: Dyspnea (dose related; 9% to 18%)

1% to 10%:

Cardiovascular: Complete atrioventricular block (1%), second degree atrioventricular block (1%), torsades de pointes (dose related; ≤4%), ventricular tachycardia (new or worsened: ≤1%)

Dermatologic: Diaphoresis (5%)

Gastrointestinal: Abdominal pain (4%), diarrhea (5% to 6%), nausea and vomiting (6% to 8%)

Neuromuscular & skeletal: Musculoskeletal pain (4%)

Ophthalmic: Visual disturbance (5%)

<1%:

Cardiovascular: Sinoatrial arrest, sinus node dysfunction, sinus pause

Nervous system: Peripheral neuropathy

Frequency not defined: Cardiovascular: Cardiac failure, hypotension, prolonged QT interval on ECG, sinus bradycardia

Postmarketing:

Dermatologic: Alopecia, pruritus, skin photosensitivity

Endocrine & metabolic: Hyperlipidemia

Hematologic & oncologic: Eosinophilia, leukopenia, thrombocytopenia

Nervous system: Altered mental status, ataxia, emotional lability, paralysis, vertigo

Neuromuscular & skeletal: Myalgia

Respiratory: Pulmonary edema

Miscellaneous: Fever

Contraindications

Hypersensitivity to sotalol or any component of the formulation; bronchial asthma or related bronchospastic conditions; sinus bradycardia (<50 bpm during waking hours); second- or third-degree AV block (unless a functioning pacemaker is present); congenital or acquired long QT syndromes; cardiogenic shock; decompensated heart failure; sick sinus syndrome; serum potassium <4 mEq/L; when used for atrial fibrillation/flutter, initiation of oral tablet is contraindicated if baseline QTc interval >450 msec; when used for atrial fibrillation/flutter or ventricular arrhythmias, oral solution is contraindicated if baseline QTc interval >450 msec.

Canadian labeling: Additional contraindications (not in the US labeling): Allergic rhinitis; severe sinus node dysfunction; concurrent use with anesthetics that produce myocardial depression.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactic reactions: Use caution with history of severe anaphylaxis to allergens; patients taking beta-blockers may become more sensitive to repeated challenges. Treatment of anaphylaxis (eg, epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects.

• Bradycardia/hypotension: May cause bradycardia (including heart block) and hypotension. Dose adjustments of agents that slow AV nodal conduction may be necessary when sotalol is initiated.

• Proarrhythmic effects: Severe and potentially fatal ventricular arrhythmias (eg, sustained ventricular tachycardia [VT]/ventricular fibrillation [VF], primarily Torsade de Pointes) may occur; females and patients with reduced creatinine clearance, reduced heart rate, higher doses, and history of sustained VT/VF or heart failure may be at increased risk. Calculation of CrCl must occur prior to administration of the first dose. Dosage should be adjusted gradually with 3 days between dosing increments to achieve steady-state concentrations, and to allow time to monitor QT intervals. Monitor and adjust dose to prevent QTc prolongation.

Disease-related concerns:

• Bronchospastic disease: In general, patients with bronchospastic disease should not receive beta-blockers; if used at all, should be used cautiously with close monitoring. Sotalol is contraindicated in patients with bronchial asthma or related bronchospastic conditions.

• Conduction abnormality: Consider preexisting conditions such as sick sinus syndrome before initiating.

• Diabetes: Use with caution in patients with diabetes mellitus; may potentiate hypoglycemia and/or mask signs and symptoms.

• Electrolyte imbalances: Correct electrolyte imbalances before initiating (especially hypokalemia and hypomagnesemia) because these conditions increase the risk of torsades de pointes.

• Heart failure: New onset or worsening heart failure may occur during initiation or titration. Use with caution in patients with compensated heart failure; monitor for a worsening of the condition and discontinue if symptoms of heart failure occur. Use is contraindicated in patients with uncontrolled (or decompensated) heart failure.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis; may worsen disease.

• Myocardial infarction: Use with caution within the first 2 weeks post myocardial infarction (MI), especially in patients with markedly impaired ventricular function (experience limited).

• Peripheral vascular disease and Raynaud disease: Can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease and Raynaud disease. Use with caution and monitor for progression of arterial obstruction.

• Pheochromocytoma (untreated): Adequate alpha-blockade is required prior to use of any beta-blocker.

• Renal impairment: CrCl must be calculated with dose initiation and dose increases. When used for atrial fibrillation/flutter, sotalol is contraindicated in patients with CrCl <40 mL/minute.

• Thyroid disease: May mask signs of hyperthyroidism (eg, tachycardia). If thyrotoxicosis is suspected, carefully manage and monitor; abrupt withdrawal may exacerbate symptoms of hyperthyroidism or precipitate thyroid storm.

Special populations:

• Older adult: Bradycardia may be observed more frequently in older adult patients (>65 years of age); dosage reductions may be necessary.

Other warnings/precautions:

• Abrupt withdrawal: Beta-blocker therapy should not be withdrawn abruptly (particularly in patients with coronary artery disease), but gradually tapered over 1 to 2 weeks to avoid acute tachycardia, hypertension, and/or ischemia. Severe exacerbation of angina, ventricular arrhythmias, and MI have been reported following abrupt withdrawal of beta-blocker therapy. Temporary but prompt resumption of beta-blocker therapy may be indicated with worsening of angina or acute coronary insufficiency. When QTc prolongation occurs, consider weighing the risk of abrupt withdrawal of sotalol with the risk of QTc prolongation. Use of an alternative beta-blocker may be indicated if worsening angina or acute coronary insufficiency occurs when sotalol is withdrawn abruptly due to QTc prolongation.

• Appropriate use: Discontinue other antiarrhythmic therapy prior to initiation and monitor patient for ≥2 to 3 plasma half-lives prior to initiating sotalol if patient’s clinical condition permits.

• Major surgery: Chronic beta-blocker therapy should not be routinely withdrawn prior to major surgery.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous, as hydrochloride:

Generic: 150 mg/10 mL (10 mL)

Solution, Oral, as hydrochloride:

Sotylize: 5 mg/mL (250 mL, 480 mL) [contains sodium benzoate; grape flavor]

Tablet, Oral, as hydrochloride:

Betapace: 80 mg, 120 mg, 160 mg [scored; contains fd&c blue #2 (indigo carm) aluminum lake]

Betapace AF: 80 mg, 120 mg, 160 mg [scored]

Sorine: 80 mg [DSC], 120 mg [DSC], 160 mg [DSC], 240 mg [DSC] [scored]

Generic: 80 mg, 120 mg, 160 mg, 240 mg

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Sotalol HCl Intravenous)

150 mg/10 mL (per mL): $434.76

Solution (Sotylize Oral)

5 mg/mL (per mL): $2.82

Tablets (Betapace AF Oral)

80 mg (per each): $18.22

120 mg (per each): $24.32

160 mg (per each): $30.41

Tablets (Betapace Oral)

80 mg (per each): $30.52

120 mg (per each): $40.73

160 mg (per each): $50.91

Tablets (Sotalol HCl Oral)

80 mg (per each): $0.23 - $2.56

120 mg (per each): $0.31 - $3.42

160 mg (per each): $0.39 - $4.27

240 mg (per each): $5.09 - $5.56

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as hydrochloride:

Generic: 80 mg, 160 mg, 240 mg

Administration: Adult

Oral: Administer without regard to meals.

When used for the management of fetal tachycardia (maternal/transplacental administration; off-label use), oral doses are administered to the mother.

IV:

Loading dose to initiate therapy or for dose escalation: Must be diluted prior to administration. Administer over 1 hour.

Substitution for oral: Must be diluted prior to administration. Administer over 5 hours; may prolong duration of infusion if QT interval prolongs to ≥500 msec.

Hemodynamically stable monomorphic VT: Administer IV push over 5 minutes; use with caution because of increased risk of adverse events (eg, bradycardia, hypotension, torsade de pointes) (Ref).

Administration: Pediatric

Oral: May be administered without regard to meals, but should be administered at the same time each day.

Parenteral:

Loading dose (acute treatment): Must be diluted prior to administration; administer over 15 to 60 minutes (Ref).

Maintenance dose (unable to take oral medications): Must be diluted prior to administration; administer over 2 to 5 hours (Ref).

Missed dose: Oral: Administer next dose at next scheduled time; do not double dose or shorten dosing interval.

Use: Labeled Indications

Atrial fibrillation/flutter, maintenance of sinus rhythm: Maintenance of normal sinus rhythm (delay in time to recurrence of atrial fibrillation/atrial flutter) in patients with symptomatic atrial fibrillation/atrial flutter who are currently in sinus rhythm.

Ventricular arrhythmias: Treatment of documented, life-threatening ventricular arrhythmias (ie, sustained ventricular tachycardia)

Use: Off-Label: Adult

Fetal tachycardia, sustained; Supraventricular tachycardia; Sustained monomorphic ventricular tachycardia, hemodynamically stable; Ventricular premature beats, symptomatic

Medication Safety Issues
Sound-alike/look-alike issues:

Sotalol may be confused with Stadol, Sudafed

Betapace may be confused with Betapace AF

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (antiarrhythmic agent, IV) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Alpha2-Agonists: Beta-Blockers may increase rebound hypertensive effects of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Alpha2-Agonists may increase AV-blocking effects of Beta-Blockers. Sinus node dysfunction may also be enhanced. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Risk D: Consider Therapy Modification

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Amiodarone: QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of Amiodarone. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Amisulpride (Oral): QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Amisulpride (Oral). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even greater risk. Risk D: Consider Therapy Modification

Antacids: May decrease serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol. Risk D: Consider Therapy Modification

Antidiabetic Agents: Beta-Blockers (Nonselective) may increase hypoglycemic effects of Antidiabetic Agents. Beta-Blockers (Nonselective) may increase adverse/toxic effects of Antidiabetic Agents. Specifically, beta-blockers may mask the hypoglycemic symptoms of antidiabetic agents. Risk C: Monitor

Antipsychotic Agents (Phenothiazines): May increase hypotensive effects of Beta-Blockers. Beta-Blockers may decrease metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease metabolism of Beta-Blockers. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Azithromycin (Systemic): QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Azithromycin (Systemic). Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: Beta-Blockers (Nonselective) may decrease bronchodilatory effects of Beta2-Agonists. Risk X: Avoid

Blood Pressure Lowering Agents: May increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Bradycardia-Causing Agents: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Cafedrine: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may decrease therapeutic effects of Cafedrine. Risk C: Monitor

Cannabis: Beta-Blockers may increase adverse/toxic effects of Cannabis. Specifically, the risk of hypoglycemia may be increased. Risk C: Monitor

Carbetocin: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Ceritinib: May increase QTc-prolonging effects of Sotalol. Ceritinib may increase bradycardic effects of Sotalol. Management: Avoid coadministration if possible. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Chloroquine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Chloroquine. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Chlorprothixene: May increase QTc-prolonging effects of Antiarrhythmic Agents (Class III). Risk X: Avoid

Cholinergic Agonists: Beta-Blockers may increase adverse/toxic effects of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Risk C: Monitor

Citalopram: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Citalopram. Risk X: Avoid

Clarithromycin: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Clarithromycin. Risk X: Avoid

Clofazimine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Clofazimine. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

ClomiPRAMINE: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

CloZAPine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of CloZAPine. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Dabrafenib: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Dasatinib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Dasatinib. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Dipyridamole: May increase bradycardic effects of Beta-Blockers. Risk C: Monitor

DOBUTamine: Beta-Blockers may decrease therapeutic effects of DOBUTamine. Risk C: Monitor

Domperidone: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Domperidone. Risk X: Avoid

Doxepin-Containing Products: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Doxepin-Containing Products. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

DroPERidol: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of DroPERidol. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

Encorafenib: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Entrectinib: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Risk X: Avoid

EPHEDrine (Systemic): Beta-Blockers may decrease therapeutic effects of EPHEDrine (Systemic). Risk C: Monitor

EPINEPHrine (Nasal): Beta-Blockers (Nonselective) may increase hypertensive effects of EPINEPHrine (Nasal). Risk C: Monitor

EPINEPHrine (Oral Inhalation): Beta-Blockers (Nonselective) may increase hypertensive effects of EPINEPHrine (Oral Inhalation). Risk C: Monitor

EPINEPHrine (Systemic): Beta-Blockers (Nonselective) may increase hypertensive effects of EPINEPHrine (Systemic). Risk C: Monitor

Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): Beta-Blockers may increase vasoconstricting effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Erythromycin (Systemic): QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of Erythromycin (Systemic). Erythromycin (Systemic) may increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Management: Avoid concomitant use of erythromycin and class III antiarrhythmic agents. Use of erythromycin with dronedarone is specifically contraindicated. Risk X: Avoid

Escitalopram: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Escitalopram. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Etelcalcetide: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Etilefrine: Beta-Blockers may decrease therapeutic effects of Etilefrine. Etilefrine may increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Etofylline: Beta-Blockers may decrease therapeutic effects of Etofylline. Risk X: Avoid

Etrasimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Fexinidazole: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Risk X: Avoid

Fingolimod: May increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Risk X: Avoid

Flecainide: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Flecainide. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Fluorouracil Products: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Fluorouracil Products. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Flupentixol: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Flupentixol. Risk X: Avoid

Gadobenate Dimeglumine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Gadobenate Dimeglumine. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Gemifloxacin: May increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Risk X: Avoid

Gilteritinib: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this combination. If use is necessary, monitor for QTc interval prolongation and arrhythmias. Risk D: Consider Therapy Modification

Grass Pollen Allergen Extract (5 Grass Extract): Beta-Blockers may increase adverse/toxic effects of Grass Pollen Allergen Extract (5 Grass Extract). More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Some other effects of epinephrine may be unaffected or even enhanced (e.g., vasoconstriction) during treatment with Beta-Blockers. Management: Consider alternatives to either grass pollen allergen extract (5 grass extract) or beta-blockers in patients with indications for both agents. Canadian product labeling specifically lists this combination as contraindicated. Risk D: Consider Therapy Modification

Halofantrine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Halofantrine. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Haloperidol: QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of Haloperidol. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

HydrOXYzine: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Imipramine: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Inotuzumab Ozogamicin: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Inotuzumab Ozogamicin. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Insulin: Beta-Blockers (Nonselective) may increase hypoglycemic effects of Insulin. Beta-Blockers (Nonselective) may decrease therapeutic effects of Insulin. Risk C: Monitor

Isoproterenol: Beta-Blockers may decrease therapeutic effects of Isoproterenol. Risk C: Monitor

Ivabradine: Bradycardia-Causing Agents may increase bradycardic effects of Ivabradine. Risk C: Monitor

Lacosamide: Antiarrhythmic Agents (Class III) may increase adverse/toxic effects of Lacosamide. Specifically the risk for bradycardia, ventricular tachyarrhythmias, or a prolonged PR interval may be increased. Risk C: Monitor

Lacosamide: Bradycardia-Causing Agents may increase AV-blocking effects of Lacosamide. Risk C: Monitor

Landiolol: Bradycardia-Causing Agents may increase bradycardic effects of Landiolol. Risk X: Avoid

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Levofloxacin-Containing Products (Systemic): May increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Risk X: Avoid

Levoketoconazole: QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of Levoketoconazole. Risk X: Avoid

Lofexidine: May increase QTc-prolonging effects of Sotalol. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mavacamten: Beta-Blockers may increase adverse/toxic effects of Mavacamten. Specifically, negative inotropic effects may be increased. Risk C: Monitor

Meglumine Antimoniate: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methacholine: Beta-Blockers may increase adverse/toxic effects of Methacholine. Risk C: Monitor

Methadone: QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of Methadone. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Midodrine: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Midostaurin: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Midostaurin. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Mivacurium: Beta-Blockers may increase therapeutic effects of Mivacurium. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Moxifloxacin (Systemic): QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Moxifloxacin (Systemic). Risk X: Avoid

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

NIFEdipine (Topical): May increase adverse/toxic effects of Beta-Blockers. Risk C: Monitor

NIFEdipine: May increase hypotensive effects of Beta-Blockers. NIFEdipine may increase negative inotropic effects of Beta-Blockers. Risk C: Monitor

Nilotinib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Nilotinib. Risk X: Avoid

Nitrendipine: May increase therapeutic effects of Beta-Blockers. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Beta-Blockers. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease antihypertensive effects of Beta-Blockers. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

OLANZapine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of OLANZapine. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Ondansetron: QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of Ondansetron. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Opipramol: Beta-Blockers may increase serum concentration of Opipramol. Opipramol may increase serum concentration of Beta-Blockers. Risk C: Monitor

Osimertinib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Osimertinib. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Oxytocin: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Ozanimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Pacritinib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Pacritinib. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

PAZOPanib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of PAZOPanib. Risk X: Avoid

Pentamidine (Systemic): QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Pentamidine (Systemic). Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Pilsicainide: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Pilsicainide. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Pimozide: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Pimozide. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk X: Avoid

Piperaquine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Piperaquine. Risk X: Avoid

Ponesimod: Bradycardia-Causing Agents may increase bradycardic effects of Ponesimod. Management: Avoid coadministration of ponesimod with drugs that may cause bradycardia when possible. If combined, monitor heart rate closely and consider obtaining a cardiology consult. Do not initiate ponesimod in patients on beta-blockers if HR is less than 55 bpm. Risk D: Consider Therapy Modification

Probucol: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Probucol. Risk X: Avoid

Propafenone: May increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Risk X: Avoid

Propofol: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

QT-prolonging Agents (Indeterminate Risk - Avoid): May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Agents (Indeterminate Risk - Caution): May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Class IA Antiarrhythmics (Highest Risk): May increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Risk X: Avoid

QT-prolonging Class III Antiarrhythmics (Highest Risk): May increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Risk X: Avoid

QT-Prolonging Inhalational Anesthetics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QT-prolonging Kinase Inhibitors (Highest Risk): May increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QT-prolonging Miscellaneous Agents (Highest Risk): QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of QT-prolonging Miscellaneous Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk): QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of QT-prolonging Class III Antiarrhythmics (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QT-prolonging Strong CYP3A4 Inhibitors (Highest Risk): QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of QT-prolonging Strong CYP3A4 Inhibitors (Highest Risk). Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk): QT-prolonging Class III Antiarrhythmics (Highest Risk) may increase QTc-prolonging effects of QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of QT-prolonging Class III Antiarrhythmics (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QUEtiapine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of QUEtiapine. Risk X: Avoid

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quizartinib: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Reserpine: May increase hypotensive effects of Beta-Blockers. Reserpine may increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Ribociclib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Ribociclib. Risk X: Avoid

RisperiDONE: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of RisperiDONE. QT-prolonging Agents (Highest Risk) may increase CNS depressant effects of RisperiDONE. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Rivastigmine: May increase bradycardic effects of Beta-Blockers. Risk X: Avoid

ROPivacaine: Antiarrhythmic Agents (Class III) may increase arrhythmogenic effects of ROPivacaine. Risk C: Monitor

Sertindole: May increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Risk X: Avoid

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Siponimod: Bradycardia-Causing Agents may increase bradycardic effects of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. If combined, consider obtaining a cardiology consult regarding patient monitoring. Risk D: Consider Therapy Modification

Sparfloxacin: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Sparfloxacin. Risk X: Avoid

Succinylcholine: Beta-Blockers may increase neuromuscular-blocking effects of Succinylcholine. Risk C: Monitor

Sulfonylureas: Beta-Blockers (Nonselective) may increase hypoglycemic effects of Sulfonylureas. Beta-Blockers (Nonselective) may decrease therapeutic effects of Sulfonylureas. Risk C: Monitor

SUNItinib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of SUNItinib. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Tasimelteon: Beta-Blockers may decrease therapeutic effects of Tasimelteon. Management: Consider avoiding nighttime administration of beta-blockers during tasimelteon therapy due to the potential for reduced tasimelteon efficacy. Risk D: Consider Therapy Modification

Terbutaline: Sotalol may decrease therapeutic effects of Terbutaline. Terbutaline may increase QTc-prolonging effects of Sotalol. Risk X: Avoid

Theodrenaline: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may decrease therapeutic effects of Theodrenaline. Risk C: Monitor

Theophylline Derivatives: Beta-Blockers (Nonselective) may decrease bronchodilatory effects of Theophylline Derivatives. Risk C: Monitor

Thioridazine: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Thioridazine. Risk X: Avoid

Toremifene: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Toremifene. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

Vemurafenib: QT-prolonging Agents (Highest Risk) may increase QTc-prolonging effects of Vemurafenib. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

White Birch Allergen Extract: Beta-Blockers may increase adverse/toxic effects of White Birch Allergen Extract. Specifically, beta-blockers may reduce the effectiveness of beta-agonists that may be required to treat systemic reactions to white birch allergen extract. Risk X: Avoid

Food Interactions

Sotalol peak serum concentrations may be decreased if taken with food. Management: Administer without regard to meals.

Reproductive Considerations

Erectile dysfunction is noted in product labeling following use of sotalol. As a class, outcomes from available studies evaluating beta-blockers and sexual dysfunction are inconsistent, and the negative effects on erectile function are considered controversial. A clear relationship between use of beta-blockers and erectile dysfunction has not been established. Patients on a beta-blocker presenting with sexual dysfunction should be evaluated for underlying disease (Farmakis 2021; Levine 2012; Semet 2017; Terentes-Printzios 2022; Viigimaa 2020).

Pregnancy Considerations

Sotalol crosses the placenta.

Adverse fetal/neonatal events have been reported with beta-blockers as a class. If maternal use of a beta-blocker is needed, monitor fetal growth during pregnancy; monitor the newborn for 48 hours after delivery for bradycardia, hypoglycemia, and respiratory depression (ESC [Regitz-Zagrosek 2018]).

Due to pregnancy-induced physiologic changes, renal clearance of sotalol is increased during pregnancy (O’Hare 1983).

Because sotalol crosses the placenta in concentrations similar to maternal serum, it has been studied for the treatment of sustained fetal tachycardia. Sotalol may be considered for the in utero management of fetal supraventricular tachycardia (SVT) or atrial flutter with hydrops or ventricular dysfunction. In cases of SVT without hydrops or ventricular dysfunction, sotalol may be considered if fetal heart rate is ≥200 bpm. Sotalol may also be used for in utero treatment of atrial flutter, and other rare tachycardias with an average fetal heart rate of ≥200 bpm. In addition, sotalol may be considered for fetal ventricular tachycardia (VT) with normal QTc with or without hydrops but is contraindicated for the treatment of fetal VT when long QT syndrome is suspected or confirmed (AHA [Donofrio 2014]).

Sotalol may be used for the treatment of maternal ventricular arrhythmias, atrial fibrillation/atrial flutter, or supraventricular tachycardia during pregnancy; consult current guidelines for specific recommendations (ACC/AHA/HRS [Page 2015]; ESC [Regitz-Zagrosek 2018]).

Breastfeeding Considerations

Sotalol is present in breast milk.

Multiple reports summarize data related to the presence of sotalol in breast milk:

• Sotalol concentrations in breast milk were evaluated in 5 patients receiving sotalol during pregnancy and continuing postpartum. Sotalol therapy started at 200 mg/day and was adjusted as required for maternal BP control (range: 200 to 800 mg/day). Twenty simultaneous milk and maternal serum concentrations were obtained (sampling times not specified). Sotalol concentrations in the breast milk ranged from 4.8 to 20.2 mcg/mL (mean: 10.5 mcg/mL) and maternal serum concentrations ranged from 0.8 to 5 mcg/mL (mean: 2.3mcg/mL). The estimated daily infant dose of sotalol via breast milk calculated by the authors of the study was 0.8 to 3.4 mg/kg/day. Bradycardia was not observed in a breastfeeding infant exposed to the highest concentration of sotalol (≤20.2 mcg/mL; fed twice at 12 days of age and monitored over a period of 8 hours); this infant was noted to have mild bradycardia at birth prior to the start of breastfeeding (maternal dose 600 mg/day) (O’Hare 1980). Using a milk concentration of 20.2 mcg/mL the relative infant dose (RID) of sotalol is 35% compared to a weight-adjusted maternal oral dose of 600 mg/day.

• Sotalol breast milk concentrations were evaluated in a case report. The mother received sotalol 80 mg 3 times/day during pregnancy; this dose was decreased to 80 mg 2 times/day 14 days postpartum. Maternal serum and breast milk samples were obtained on postpartum days 5 and 105. Maternal serum concentrations on day 5 were 0.72 mcg/mL, 6.5 hours after the dose. Corresponding milk concentrations were 4.06 mcg/mL (prefeed: 6.3 hours after the dose) and 3.65 mcg/mL (postfeed: 7 hours after the dose). Maternal serum concentrations on day 105 were 0.97 mcg/mL (2.8 hours after the dose) and milk concentrations ranged from 2.36 mcg/mL (2.8 hours after the dose) to 3.16 mcg/mL (3.3 hours after the dose). The estimated daily infant dose of sotalol via breast milk calculated by the authors of the study was 0.41 to 0.58 mg/kg/day, providing a RID of 20% to 23% compared to a weight adjusted maternal dose of 2.29 to 4.57 mg/kg/day. Adverse events were not observed in the breastfed infant (Hackett 1990).

• Sotalol was measurable in breast milk following maternal use of sotalol 80 mg in combination with flecainide. Both medications were administered twice daily prior to and throughout pregnancy. Breast milk was sampled 3 hours after the second dose on postpartum days 5 and 7. Breast milk concentrations were 5 mcg/mL (postpartum day 5) and 4.4 mcg/mL (postpartum day 7) (Wagner 1990).

• Product labeling estimates the RID of sotalol to be 22% to 22.5% of a weight adjusted maternal dose. In general, breastfeeding is considered acceptable when the RID of a medication is <10%; when the RID is >25% breastfeeding should generally be avoided (Anderson 2016; Ito 2000). Additional considerations can include the gestational and postnatal age of the infant, the actual amount of milk being ingested (less in the first couple days of life and when weaning), properties of the specific maternal medication, medical conditions of the infant, and medications the infant is receiving therapeutically

The manufacturer recommends breastfeeding be discontinued during sotalol therapy. Closely monitor infants exposed to sotalol via breast milk for adverse events such as bradycardia, hypotension, respiratory distress, hypoglycemia (Hackett 1990) as well as diarrhea, constipation, and dry mouth, skin, or eyes.

Monitoring Parameters

Serum creatinine (creatinine clearance), magnesium, potassium; heart rate, blood pressure; ECG (eg, QTc interval, PR interval); serum glucose (in patients with diabetes); signs and symptoms of heart failure.

Oral: During initiation and titration period, monitor QTc interval 2 to 4 hours after each dose. If QTc interval is ≥500 msec, reduce dose, prolong the dosing interval, or discontinue sotalol. If the QTc interval is <500 msec after 3 days (after fifth or sixth dose if patient receiving once-daily dosing), patient may be discharged on current regimen. Monitor QTc interval periodically thereafter.

IV:

Loading dose to initiate therapy or for dose escalation: Refer to table in adult or renal dosing sections.

Substitution for oral: Measure QTc interval after completion of each infusion.

Consult individual institutional policies and procedures.

Mechanism of Action

Beta-blocker which contains both beta-adrenoreceptor-blocking (Vaughan Williams Class II) and cardiac action potential duration prolongation (Vaughan Williams Class III) properties

Class II effects: Increased sinus cycle length, slowed heart rate, decreased AV nodal conduction, and increased AV nodal refractoriness Sotalol has both beta1- and beta2-receptor blocking activity. The beta-blocking effect of sotalol is a noncardioselective (half maximal at about 80 mg/day and maximal at doses of 320 to 640 mg/day). Significant beta-blockade occurs at oral doses as low as 25 mg/day.

Class III effects: Prolongation of the atrial and ventricular monophasic action potentials, and effective refractory prolongation of atrial muscle, ventricular muscle, and atrioventricular accessory pathways in both the antegrade and retrograde directions. Sotalol is a racemic mixture of d- and l-sotalol; both isomers have similar Class III antiarrhythmic effects while the l-isomer is responsible for virtually all of the beta-blocking activity. The Class III effects are seen only at oral doses ≥160 mg/day.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action:

Oral: Rapid; at 1 to 2 hours post dosing (steady-state), reductions in heart rate and cardiac index seen (Winters 1993).

IV: When administered IV over 5 minutes for ongoing VT, onset of action is ~5 to 10 minutes (Ho 1994).

Absorption: Oral: Well absorbed (Hanyok 1993); decreased ~20% by meals compared with fasting.

Distribution: Vd: 1.2 to 2.4 L/kg (Hanyok 1993).

Protein binding: None.

Metabolism: None.

Bioavailability: Oral: 90% to 100%.

Half-life elimination:

Oral:

Neonates ≤1 month: 8.4 ± 0.3 hours (Saul 2001).

Infants and Children >1 month to 24 months: 7.4 ± 1.8 hours (Saul 2001).

Children >2 years to <7 years: 9.1 ± 2.9 hours (Saul 2001).

Children 7 to 12 years: 9.2 ± 3 hours (Saul 2001).

Adults: 12 hours; adults with renal failure (anuric): Up to 69 hours.

IV: Pharmacokinetics of the IV formulation (administered over 5 hours) are similar to the oral formulations (Somberg 2010).

Time to peak, serum: Oral: Infants and Children 3 days to 12 years: Mean range: 2 to 3 hours; Adults: 2.5 to 4 hours.

Excretion: Urine (as unchanged drug).

Clearance (apparent) (Saul 2001):

Neonates ≤1 month: 11 ± 2 mL/minute.

Infants and Children >1 month to 24 months: 32 ± 14 mL/minute.

Children >2 years to <7 years: 63 ± 21 mL/minute.

Children 7 to 12 years: 95 ± 32 mL/minute.

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Terminal half-life increases with renal impairment.

Brand Names: International
International Brand Names by Country
  • (AE) United Arab Emirates: Apo-sotalol | Sotacor | Sotalol;
  • (AR) Argentina: Darob | Ritmic | Sotacor;
  • (AT) Austria: Sotacor | Sotahexal | Sotalol-arcana | Sotamed | Sotastad;
  • (AU) Australia: Apo-sotalol | Apx sotalol | Cardol | Cm sotalol | Dbl sotalol | Genrx sotalol | Solavert | Sotab | Sotacor | Sotahexal | Sotalol | Sotalol-bc | Tw sotalol;
  • (BE) Belgium: Sotalex | Sotalol bexal | Sotalol merck-generics | Sotalol Sandoz;
  • (BG) Bulgaria: Darob | Gilucor | Sotagamma | Sotahexal | Sotalex | Sotanorm;
  • (BR) Brazil: Cloridrato de sotalol | Sotacor | Sotahexal;
  • (CH) Switzerland: Sotalex | Sotalol mepha;
  • (CL) Chile: Hipecor;
  • (CN) China: Darob | Ji di | Sotacor | Sotalol | Tan shi | Wei Te | Xi an lin;
  • (CO) Colombia: Darob | Sotacor;
  • (CZ) Czech Republic: Sotahexal | Sotalex | Sotalol | Sotalol al;
  • (DE) Germany: Corsotalol | Darob | Favorex | Gilucor | Jutalex | Rentibloc | Sota | Sota gry | Sota lich | Sota saar | Sota-puren | Sotabeta | Sotagamma | Sotahexal | Sotalex | Sotalodoc | Sotalol | Sotalol acis | Sotalol Actavis | Sotalol al | Sotalol Atid | Sotalol Billix | Sotalol carinopharm | Sotalol Corax | Sotalol ct | Sotalol Ratiopharm | Sotalol Sandoz | Sotalol Vem | Sotalol Winthrop | Sotamerck | Sotaryt | Sotastad | Tachytalol;
  • (DK) Denmark: Sotacor | Sotalol nm;
  • (EC) Ecuador: Sotaper;
  • (EE) Estonia: Darob | Loritmik | Sotahexal | Sotalex | Sotalol | Sotastad;
  • (EG) Egypt: Betacor | Sotaloc;
  • (ES) Spain: Sotapor;
  • (FI) Finland: Sotacor | Sotalin | Sotalol alpharma | Sotalol generics | Sotalol Merck NM | Sotalol Sandoz;
  • (FR) France: Sotalex | Sotalol | Sotalol Almus | Sotalol arrow | Sotalol biogaran | Sotalol g gam | Sotalol gnr | Sotalol irex | Sotalol ivax | Sotalol merck | Sotalol ranbaxy | Sotalol Ratiopharm | Sotalol rpg | Sotalol Sandoz | Sotalol teva;
  • (GB) United Kingdom: Beta Cardone | Sotacor | Sotalol | Sotalol Almus | Sotalol arrow | Sotalol kent | Sotalol Sandoz;
  • (GR) Greece: Sotalex | Sotalol | Sotalol/mylan;
  • (HK) Hong Kong: Apo-sotalol | Sotacor;
  • (HR) Croatia: Darob | Darob mite;
  • (HU) Hungary: Gilucor | Sotahexal | Sotalex | Sotalol al | Sotalol knoll;
  • (ID) Indonesia: Sotacor;
  • (IE) Ireland: Beta Cardone | Sotacor | Sotoger;
  • (IL) Israel: Sotacor | Sotalol GM;
  • (IN) India: Solet | Sotalar;
  • (IT) Italy: Rytmobeta | Sotalex | Sotalolo | Sotalolo Errekappa;
  • (JP) Japan: Sotacor | Sotalol hydrochloride te;
  • (KR) Korea, Republic of: Betalex | Rentibloc | Sotalon;
  • (LB) Lebanon: Sotalol biogaran;
  • (LT) Lithuania: Darob | Sotagamma | Sotalex | Sotalol 1 A pharma | Sotalol al | Sotalol ct | Sotalol mylan | Sotalol Ratiopharm | Sotalol rph | Sotalol teva;
  • (LU) Luxembourg: Sotalex;
  • (LV) Latvia: Darob | Sotagama | Sotagamma | Sotalex | Sotalol | Sotalol 1 A pharma | Sotastad;
  • (MA) Morocco: Sotalex;
  • (MX) Mexico: Hipecor | Sotalol | Sotaper;
  • (MY) Malaysia: Sopressor | Sotacor;
  • (NL) Netherlands: Sotacor | Sotalol HCL | Sotalol hcl actavis | Sotalol hcl aurobindo | Sotalol hcl teva | Sotalol hcl tiofarma;
  • (NO) Norway: Sotabet | Sotacor | Sotalex | Sotalol;
  • (NZ) New Zealand: Apo-sotalol | Sotacor | Sotalol;
  • (PH) Philippines: Sotalex;
  • (PL) Poland: Biosotal | Darob | Gilucor | Sotahexal | Sotalex | Sotalol | Sotalol aurovitas;
  • (PR) Puerto Rico: Betapace | Betapace af | Sorine | Sotalol | Sotalol af | Sotalol HCL;
  • (PT) Portugal: Darob | Sotacor | Sotalol aurobindo | Sotalol Sandoz;
  • (RO) Romania: Darob;
  • (RU) Russian Federation: Sotagexal | Sotahexal | Sotalex | Sotalol | Sotalol avexima | Sotalol canon | Tensol;
  • (SA) Saudi Arabia: Apo-sotalol | Betacor | Pms-sotalol;
  • (SE) Sweden: Sotacor | Sotalol | Sotalol ebb | Sotalol Merck NM | Sotalol mylan;
  • (SG) Singapore: Apo-sotalol | Sotacor | Sotahexal;
  • (SI) Slovenia: Darob;
  • (SK) Slovakia: Sotalex | Sotalol;
  • (SR) Suriname: Sotalar | Sotalol | Sotalol HCL | Sotalol hcl aurobindo;
  • (TH) Thailand: Sotacor;
  • (TN) Tunisia: Sotalex | Sotalol mylan;
  • (TR) Turkey: Darob | Sotarit | Talozin;
  • (TW) Taiwan: Cardol | Darob | Sotacor | Sotalex;
  • (UA) Ukraine: Gilucor | Soritmik | Sotahexal;
  • (UY) Uruguay: Alosot | Sotacor;
  • (ZA) South Africa: Sotacor | Sotahexal
  1. A Comparison of Antiarrhythmic-Drug Therapy With Implantable Defibrillators in Patients Resuscitated From Near-Fatal Ventricular Arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med. 1997;337(22):1576-1583. [PubMed 9411221]
  2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published online October 30, 2017]. Circulation. doi: 10.1161/CIR.0000000000000549. [PubMed 29084731]
  3. Alsaied T, Baskar S, Fares M, et al. First-line antiarrhythmic transplacental treatment for fetal tachyarrhythmia: a systematic review and meta-analysis. J Am Heart Assoc. 2017;6(12):e007164. doi:10.1161/JAHA.117.007164 [PubMed 29246961]
  4. American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 203: chronic hypertension in pregnancy. Obstet Gynecol. 2019;133(1):e26-e50. [PubMed 30575676]
  5. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
  6. APO-Sotalol (sotalol hydrochloride) tablets BP [product monograph]. Weston, Ontario, Canada: Apotex Inc; July 2022.
  7. Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. American College of Physicians; 2007.
  8. Beaufort-Krol GC, Bink-Boelkens MT. Effectiveness of Sotalol for Atrial Flutter in Children After Surgery for Congenital Heart Disease. Am J Cardiol. 1997;79(1):92-94. [PubMed 9024748]
  9. Betapace/Betapace AF (sotalol) [prescribing information]. Zug, Switzerland: Covis Pharma; June 2023.
  10. Blair AD, Burgess ED, Maxwell BM, Cutler RE. Sotalol kinetics in renal insufficiency. Clin Pharmacol Ther. 1981;29(4):457-463. doi:10.1038/clpt.1981.63 [PubMed 7471612]
  11. Borquez AA, Aljohani OA, Williams MR, Perry JC. Intravenous sotalol in the young: safe and effective treatment with standardized protocols. JACC Clin Electrophysiol. 2020;6(4):425-432. doi:10.1016/j.jacep.2019.11.019 [PubMed 32327076]
  12. Colloridi V, Perri C, Ventriglia F, et al. Oral Sotalol in Pediatric Atrial Ectopic Tachycardia. Am Heart J. 1992;123(1):254-256. [PubMed 1729843]
  13. Dancey D, Wulffhart Z, McEwan P. Sotalol-induced torsades de pointes in patients with renal failure. Can J Cardiol. 1997;13(1):55-58. [PubMed 9039065]
  14. Donofrio MT, Moon-Grady AJ, Hornberger LK, et al; American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014;129(21):2183-2242. doi:10.1161/01.cir.0000437597.44550.5d [PubMed 24763516]
  15. Erkkola R, Lammintausta R, Liukko P, Anttila M. Transfer of propranolol and sotalol across the human placenta. Their effect on maternal and fetal plasma renin activity. Acta Obstet Gynecol Scand. 1982;61(1):31-34. [PubMed 7046334]
  16. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  17. Farmakis IT, Pyrgidis N, Doundoulakis I, Mykoniatis I, Akrivos E, Giannakoulas G. Effects of major antihypertensive drug classes on erectile function: a network meta-analysis. Cardiovasc Drugs Ther. 2022;36(5):903-914. doi:10.1007/s10557-021-07197-9 [PubMed 33945044]
  18. Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive Summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18)(suppl 3):S640-S656. [PubMed 20956217]
  19. Foster CA, Aston SJ. Propranolol-Epinephrine Interaction: A Potential Disaster. Plast Reconstr Surg. 1983;72(1):74-78. [PubMed 6867180]
  20. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi:10.1210/jc.2015-4061 [PubMed 26934393]
  21. Hackett LP, Wojnar-Horton RE, Dusci LJ, et al. Excretion of Sotalol in Breast Milk. Br J Clin Pharmacol. 1990;29(2):277-278. [PubMed 2306424]
  22. Hanyok JJ. Clinical pharmacokinetics of sotalol. Am J Cardiol. 1993;72:19A-26A. [PubMed 8346722]
  23. Hill GD, Kovach JR, Saudek DE, Singh AK, Wehrheim K, Frommelt MA. Transplacental treatment of fetal tachycardia: a systematic review and meta-analysis. Prenat Diagn. 2017;37(11):1076-1083. doi:10.1002/pd.5144 [PubMed 28833310]
  24. Ho DS, Zecchin RP, Cooper MJ, Richards DA, Uther JB, Ross DL. Rapid intravenous infusion of d-l sotalol: time to onset of effects on ventricular refractoriness, and safety. Eur Heart J. 1995;16(1):81-86. [PubMed 7737227]
  25. Ho DS, Zecchin RP, Richards DA, Uther JB, Ross DL. Double-blind trial of lignocaine versus sotalol for acute termination of spontaneous sustained ventricular tachycardia. Lancet. 1994;344(8914):18-23. doi:10.1016/s0140-6736(94)91048-0 [PubMed 7912296]
  26. Ho TK, Moretti ME, Schaeffer JK, et al. Maternal [beta]-blocker usage and breast feeding in the neonate. [Abstract] Pediatric Research. 45(4) (PART 2 OF 2):67A.
  27. Huynh-Do U, Wahl C, Sulzer M, Bühler H, Keusch G. Torsades de pointes during low-dosage sotalol therapy in haemodialysis patients. Nephrol Dial Transplant. 1996;11(6):1153-1154. [PubMed 8671988]
  28. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
  29. Jaeggi ET, Carvalho JS, De Groot E, et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation. 2011;124(16):1747-1754. doi:10.1161/CIRCULATIONAHA.111.026120 [PubMed 21931080]
  30. Kuhlkamp V, Mewis C, Mermi J, et al. Suppression of Sustained Ventricular Tachyarrhythmias: A Comparison of d,1-Sotalol With No Antiarrhythmic Drug Treatment. J Am Coll Cardiol. 1999;33(1):46-52. [PubMed 9935007]
  31. Läer S, Elshoff JP, Meibohm B, et al. Development of a Safe and Effective Pediatric Dosing Regimen for Sotalol Based on Population Pharmacokinetics and Pharmacodynamics in Children With Supraventricular Tachycardia. J Am Coll Cardiol. 2005;46(7):1322-1330. [PubMed 16198851]
  32. Lang DM. Anaphylactoid and Anaphylactic Reactions. Hazards of Beta-Blockers. Drug Saf. 1995;12(5):299-304. [PubMed 7669259]
  33. Levine GN, Steinke EE, Bakaeen FG, et al; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Quality of Care and Outcomes Research. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2012;125(8):1058-1072. doi:10.1161/CIR.0b013e3182447787 [PubMed 22267844]
  34. Li X, Zhang Y, Liu H, Jiang H, Ge H, Zhang Y. Efficacy of intravenous sotalol for treatment of incessant tachyarrhythmias in children. Am J Cardiol. 2017;119(9):1366-1370. doi:10.1016/j.amjcard.2017.01.034 [PubMed 28283175]
  35. Malloy-Walton LE, Von Bergen NH, Balaji S, et al. IV Sotalol use in pediatric and congenital heart patients: a multicenter registry study. J Am Heart Assoc. 2022;11(9):e024375. doi:10.1161/JAHA.121.024375 [PubMed 35491986]
  36. Manolis AS. Ventricular premature beats. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 26, 2018.
  37. Maragnes P, Tipple M, Fournier A. Effectiveness of Oral Sotalol for Treatment of Pediatric Arrhythmias. Am J Cardiol. 1992;69(8):751-754. [PubMed 1546649]
  38. Mason JW. A Comparison of Seven Antiarrhythmic Drugs in Patients With Ventricular Tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators. N Engl J Med. 1993;329(7):452-458. [PubMed 8332150]
  39. Namouz-Haddad S, Koren G. Fetal pharmacotherapy 2: fetal arrhythmia. J Obstet Gynaecol Can. 2013;35(11):1023-1027. [PubMed 24246403]
  40. Neumar RW, Otto CW, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 suppl 3):s729-s767. [PubMed 20956224]
  41. O'Hare MF, Leahey W, Murnaghan GA, et al. Pharmacokinetics of Sotalol During Pregnancy. Eur J Clin Pharmacol. 1983;24(4):521-524. [PubMed 6861867]
  42. O'Hare MF, Murnaghan GA, Russell CJ. Sotalol as a Hypotensive Agent in Pregnancy. Br J Obstet Gynaecol. 1980;87(9):814-820. [PubMed 7426541]
  43. Oudijk MA, Michon MM, Kleinman CS, et al. Sotalol in the treatment of fetal dysrhythmias. Circulation. 2000;101(23):2721-2726. doi:10.1161/01.cir.101.23.2721 [PubMed 10851210]
  44. Pacifico A, Hohnloser SH, Williams JH, et al. Prevention of Implantable-Defibrillator Shocks by Treatment With Sotalol. d,1-Sotalol Implantable Cardioverter-Defibrillator Study Group. N Engl J Med. 1999;340(24):1855-1862. [PubMed 10369848]
  45. Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016;67(13):e27-e115. [PubMed 26409259]
  46. Pfammatter JP, Paul T. New Antiarrhythmic Drug in Pediatric Use: Sotalol. Pediatr Cardiol. 1997;18(1):28-34. [PubMed 8960489]
  47. Pfammatter JP, Paul T, Lehmann C, et al. Efficacy and Proarrhythmia of Oral Sotalol in Pediatric Patients. J Am Coll Cardiol. 1995;26(4):1002-1007. [PubMed 7560592]
  48. Qin J, Deng Z, Tang C, et al. Efficacy and safety of various first-line therapeutic strategies for fetal tachycardias: a network meta-analysis and systematic review. Front Pharmacol. 2022;13:935455. doi:10.3389/fphar.2022.935455 [PubMed 35770083]
  49. Refer to manufacturer's labeling.
  50. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. [PubMed 30165544]
  51. Rizza C, Valderrabano M, Singh BN. Recurrent torsades de pointes after sotalol therapy for symptomatic paroxysmal atrial fibrillation in a patient with end-stage renal disease. J Cardiovasc Pharmacol Ther. 1999;4(2):129-134. doi:10.1177/107424849900400208 [PubMed 10684532]
  52. Rochelson E, Valdés SO, Asadourian V, et al. Sotalol versus amiodarone for postoperative junctional tachycardia after congenital heart surgery. Heart Rhythm. 2022;19(3):450-456. doi:10.1016/j.hrthm.2021.11.021 [PubMed 34801734]
  53. Saul JP, Schaffer MS, Karpawich PP, et al. Single-Dose Pharmacokinetics of Sotalol in a Pediatric Population With Supraventricular and/or Ventricular Tachyarrhythmia. J Clin Pharmacol. 2001;41(1):35-43.
  54. Semet M, Paci M, Saïas-Magnan J,et al. The impact of drugs on male fertility: a review. Andrology. 2017;5(4):640-663. doi:10.1111/andr.12366 [PubMed 28622464]
  55. Shah A, Moon-Grady A, Bhogal N, et al. Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. Am J Cardiol. 2012;109(11):1614-1618. doi:10.1016/j.amjcard.2012.01.388 [PubMed 22444730]
  56. Skanes AC, Healey JS, Cairns JA, et al. Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control. Can J Cardiol. 2012;28(2):125-36. [PubMed 22433576]
  57. Somberg JC, Preston RA, Ranade V, Molnar J. Developing a safe intravenous sotalol dosing regimen. Am J Ther. 2010;17(4):365-372. [PubMed 20562595]
  58. Somberg JC, Vinks AA, Dong M, Molnar J. Model-informed development of sotalol loading and dose escalation employing an intravenous infusion. Cardiol Res. 2020;11(5):294-304. doi:10.14740/cr1143 [PubMed 32849964]
  59. Sonesson SE, Fouron JC, Wesslen-Eriksson E, et al. Foetal Supraventricular Tachycardia Treated With Sotalol. Acta Paediatr. 1998;87(5):584-587. doi:10.1080/08035259850158335 [PubMed 9641744]
  60. Sorine (sotalol) [prescribing information]. Maple Grove, MN: Upsher-Smith Laboratories LLC; April 2021.
  61. Sotalol hydrochloride injection [prescribing information]. Chicago, IL: Altathera Pharmaceuticals LLC; November 2020.
  62. Sotalol hydrochloride injection [prescribing information]. Chicago, IL: Altathera Pharmaceuticals LLC; September 2023.
  63. Sotalol hydrochloride injection [product monograph]. Weston, Ontario, Canada: Apotex Inc; December 2021.
  64. Sotylize (sotalol) [prescribing information]. Woburn, MA: Azurity Pharmaceuticals; January 2024.
  65. Tang S, Lo CY, Lo WK, et al. Sotalol-induced Torsade de pointes in a CAPD patient--successful treatment with intermittent peritoneal dialysis. Perit Dial Int. 1997;17(2):207-208. [PubMed 9159848]
  66. Terentes-Printzios D, Ioakeimidis N, Rokkas K, Vlachopoulos C. Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nat Rev Cardiol. 2022;19(1):59-74. doi:10.1038/s41569-021-00593-6 [PubMed 34331033]
  67. Tipple M, Sandor G. Efficacy and Safety of Oral Sotalol in Early Infancy. Pacing Clin Electrophysiol. 1991;14(11, pt 2):2062-2065. [PubMed 1721225 ]
  68. Tjandramaga TB, Verbeeck R, Thomas J, Verbesselt R, Verberckmoes R, Schepper PJ. The effect of end-stage renal failure and haemodialysis on the elimination kinetics of sotalol. Br J Clin Pharmacol. 1976;3(2):259-265. doi:10.1111/j.1365-2125.1976.tb00601.x [PubMed 973960]
  69. Valdés SO, Miyake CY, Niu MC, et al. Early experience with intravenous sotalol in children with and without congenital heart disease. Heart Rhythm. 2018;15(12):1862-1869. doi:10.1016/j.hrthm.2018.07.010 [PubMed 30003959]
  70. van der Heijden LB, Oudijk MA, Manten GT, ter Heide H, Pistorius L, Freund MW. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Ultrasound Obstet Gynecol. 2013;42(3):285-293. doi:10.1002/uog.12390 [PubMed 23303470]
  71. Viigimaa M, Vlachopoulos C, Doumas M, et al; European Society of Hypertension Working Group on Sexual Dysfunction. Update of the position paper on arterial hypertension and erectile dysfunction. J Hypertens. 2020;38(7):1220-1234. doi:10.1097/HJH.0000000000002382 [PubMed 32073535]
  72. Wagner X, Jouglard J, Moulin M, Miller AM, Petitjean J, Pisapia A. Coadministration of flecainide acetate and sotalol during pregnancy: lack of teratogenic effects, passage across the placenta, and excretion in human breast milk. Am Heart J. 1990;119(3 Pt 1):700-702. doi:10.1016/s0002-8703(05)80306-0 [PubMed 1689933]
  73. Waldo AL, Camm AJ, deRuyter H, et al. Effect of d-sotalol on Mortality in Patients With Left Ventricular Dysfunction After Recent and Remote Myocardial Infarction. The SWORD Investigators. Survival With Oral d-Sotalol. Lancet. 1996;348(9019):7-12. [PubMed 8691967]
  74. Winters SL, Kukin M, Pe E, et al. Effect of oral sotalol on systemic hemodynamics and programmed electrical stimulation in patients with ventricular arrhythmias and structural heart disease. Am J Cardiol. 1993;72:38A-43A. [PubMed 8346725]
  75. Wong DG, Spence JD, Lamki L, et al. Effect of Nonsteroidal Anti-inflammatory Drugs on Control of Hypertension of Beta-Blockers and Diuretics. Lancet. 1986;1(8488):997-1001. [PubMed 2871333]
  76. Wynn RL. Dental Nonsteroidal Anti-inflammatory Drugs and Prostaglandin-Based Drug Interactions, Part Two. Gen Dent. 1992;40(2):104, 106, 108. [PubMed 1354194]
  77. Wynn RL. Epinephrine Interactions With Beta-Blockers. Gen Dent. 1994;42(1):16, 18. [PubMed 7911769]
  78. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. 2006;48(5):247-346. [PubMed 16949478]
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