Sotalol
BETAPACE
Pronunciation: SOE-ta-loel
“Better pace (yourself), Soda, LOL”
LOL hat → beta blocker
QT prolongation
What it isBeta-1 antagonist with hERG blockade; atrial fibrillation and ventricular arrhythmias.
Why this oneUnlike ordinary beta blockers, hERG blockade adds rhythm maintenance — and substantial torsades risk.
What limits itInitiate with continuous ECG monitoring; renal clearance requires dose adjustment, and abrupt withdrawal is unsafe.
Sotalol prescription history
Animated chart of estimated U.S. prescriptions per year, Antiarrhythmics (class I/III) (1930–2026). Sotalol enters in 1993 (estimated).
FDA-approved for
- ventricular arrhythmias (1992)
- atrial fibrillation (2000)
Sulfonamide
Sulfonamide-derived drug — label silent
A sulfonamide by structure, without the N4 aromatic amine or N1 heterocycle; the label carries no sulfonamide warning, and Khan lists it among drugs with no or weak evidence of cross-reactivity.
Open the sulfonamide hypersensitivity presentation → · sources [n] are on its References slide.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMarked QT prolongation and torsades risk require renal dosing and monitored initiation in many patients.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Ventricular arrhythmias | Adults | 80 mg BID | 160–320 mg/day (2–3 divided doses) | 320 mg/day (up to 480–640 mg/day in refractory cases) |
| Recurrence of AFIB/AFL | Adults | 80 mg BID | 120 mg BID | — |
| Ventricular arrhythmias or AFIB/AFL | Pediatric ≥~2 y (normal renal function) | 1.2 mg/kg TID | Titrate by response, HR, QTc; ≥36 h between increments, preferably in-hospital | 2.4 mg/kg TID |
| Ventricular arrhythmias or AFIB/AFL | Pediatric ≤~2 y | 1.2 mg/kg TID × age factor (1 month: ×0.7 = 0.8 mg/kg TID; ~1 week: ×0.3 = 0.4 mg/kg) | Titrate using the same age-factor calculation | Undefined (age-factor reduction applies to titration) |
Titration Increase in increments of 80 mg/day every 3 days (provided QTc <500 msec)
Renal Adjust the dosing interval based on creatinine clearance
Hepatic Undefined
Monitor QTc 2–4 hours after each dose uptitration; reduce dose or discontinue if QT ≥500 msec
Instructions
- Withdraw other antiarrhythmic therapy before starting
- Hospitalize for at least 3 days (or until steady state) on initiation/reinitiation with continuous ECG monitoring
- Correct hypokalemia and hypomagnesemia before initiating
- Do not abruptly discontinue (risk of coronary artery disease exacerbation)
- If a dose is missed, take the next dose at the usual time; do not double
Available strengths
- tab 80, 120, 160, 240 mg
- sol 5 mg/mL
- inj 15 mg/mL
Contraindications
- Sinus bradycardia, sick sinus syndrome, or 2nd/3rd degree AV block (unless a functioning pacemaker is present)
- Congenital or acquired long QT syndrome
- Cardiogenic shock or decompensated heart failure
- Serum potassium <4 mEq/L
- Bronchial asthma or related bronchospastic conditions
- Baseline QT interval >450 msec (for AFIB/AFL)
Cautions
- QT prolongation and proarrhythmia (Torsade de Pointes)
- Bradycardia / heart block / sick sinus syndrome
- Hypotension
- New-onset or worsening heart failure
- Do not abruptly discontinue (coronary artery disease exacerbation)
- May mask hypoglycemia symptoms or worsen hyperglycemia
- Correct electrolyte disturbances
Adverse reactions
- Fatigue
- Bradycardia (<50 bpm)
- Dyspnea
- Proarrhythmia
- Asthenia
- Dizziness
Pregnancy Crosses placenta; fetal risks incl. growth restriction, bradycardia, hypoglycemia, possible intrauterine death; monitor neonate for beta-blockade
Lactation Present in human milk at high levels; do not breastfeed during treatment
Cost
Generic entry2000
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Memory aids: interaction avatars
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Self-check
- What distinguishes sotalol from ordinary beta blockers?
hERG blockade adds rhythm maintenance. - What monitoring is required at sotalol initiation?
Continuous ECG monitoring.