Sotalol

What it is used for

• General antiarrhythmic
• For ventricular tachyarrhythmias
• General antiarrhythmic
• General antiarrhythmic
• Ventricular arrhythmias
• General antiarrhythmic
• General antiarrhythmic
• For ventricular tachycardia
• For ventricular tachyarrhythmias in Boxers in combination with mexiletine
• In Boxers
• Ventricular arrhythmias
• Ventricular arrhythmias (Acute/Severe)

How it is given

Possible side effects

• Negative inotropism (decreased heart contractility)
• Proarrhythmia (can induce new or worsen existing arrhythmias)
• Dyspnea / Bronchospasm
• Fatigue / Lethargy
• Dizziness / Syncope exacerbation
• Nausea / Vomiting
• Bradycardia
• Hypotension
• Bradyarrhythmias
• Bronchospasm
• Depression
• Nausea
• Vomiting
• Diarrhoea
• Decreased cardiac output
• Precipitation of congestive heart failure
• Prolonged QT interval
• Torsades de pointes (proarrhythmic effect)

Cautions & contraindications

• Asthma or reactive airway disease
• Sinus bradycardia
• 2nd or 3rd degree AV block (unless artificially paced)
• Long QT syndromes
• Cardiogenic shock
• Uncontrolled congestive heart failure (CHF)
• Asthma
• Atrioventricular (AV) block
• Decompensated congestive heart failure (CHF)
• Long QT interval on ECG
• Use with caution in patients with congestive heart failure (due to negative inotropic effects), diabetes mellitus, or hyperthyroidism (may mask clinical signs of hypoglycemia or thyrotoxicosis). Use with caution in patients with renal dysfunction; dosage intervals may need to be extended as it is renally excreted. Safety in pregnancy is not fully established (FDA Category B). Sotalol enters maternal milk at up to 5x serum concentrations; consider milk replacer for nursing animals.

Drug interactions

• Amiodarone: May prolong refractory periods; concurrent use not recommended.
• Anesthetics, General: Additive myocardial depression may occur.
• Antacids: May reduce oral sotalol absorption; separate doses by at least 2 hours.
• Antiarrhythmics, Class IA (quinidine, procainamide, disopyramide): May prolong refractory periods and QT interval; concurrent use not recommended.
• Antiarrhythmics, Class IB/IC (lidocaine, mexiletine, phenytoin, flecainide): May prolong QT interval.
• Calcium Channel Blockers (verapamil, diltiazem): Potential to increase hypotensive effects; additive effects on AV conduction or ventricular function. Use with caution.
• Cisapride: May prolong QT interval.
• Clonidine: Increased risk for rebound hypertension if clonidine is discontinued after concomitant therapy.
• Digoxin: Potential for increased risks for proarrhythmic events.
• Erythromycin / Clarithromycin: May prolong QT interval.
• Lidocaine: Clearance of lidocaine may be impaired by sotalol.
• Phenothiazines: May prolong QT interval.
• Reserpine: May have additive hypotensive and bradycardic effects.
• Sympathomimetics / Beta-2 Agonists (metaproterenol, terbutaline, albuterol): Actions may be blocked by sotalol.
• Tricyclic Antidepressants: May prolong QT interval.
• Sympathomimetics (e.g., terbutaline, phenylpropanolamine, adrenaline): Mutual antagonism; sotalol may block their actions, and they may reduce sotalol's efficacy.
• Beta-blockers: Additive myocardial depression.
• Myocardial depressant anaesthetic agents: Additive myocardial depression.
• Furosemide: Enhanced hypotensive effects; risk of hypokalaemia which increases risk of torsades de pointes.
• Hydralazine and other vasodilators: Enhanced hypotensive effects.
• Insulin: May prolong hypoglycaemic effects of insulin therapy.
• Calcium-channel blockers (negative inotropics): Additive negative inotropic effects; use with extreme caution in patients with systolic dysfunction or CHF.

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