Sotalol

FDA label

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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

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