Sotalol Hydrochloride(soh’ tal lole)
Apo-Sotalol (CAN), Betapace, Betapace AF, Gen-Sotalol (CAN), PMS-Sotalol (CAN), ratio-Sotalol (CAN), Sorine
PREGNANCY CATEGORY B
Drug Classes
Antiarrhythmic, classes II and III
Beta-adrenergic blocker
Therapeutic Actions
Blocks beta-adrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus (kidneys), thus decreasing the excitability of the heart, decreasing cardiac output and oxygen consumption.
Indications
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Treatment of life-threatening ventricular arrhythmias; because of proarrhythmic effects, use for less than life-threatening arrhythmias, even symptomatic ones, is not recommended
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Betapace AF: Maintenance of normal sinus rhythm—to delay the time to recurrence of atrial fibrillation or flutter in patients with symptomatic atrial fibrillation or flutter who are currently in sinus rhythm
Contraindications and Cautions
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Contraindicated with bronchial asthma (Betapace), sinus bradycardia (HR less than 45 beats/min), second- or third-degree heart block (PR interval greater than 0.24 sec), cardiogenic shock, uncontrolled HF, lactation, congenital or acquired long QT syndromes, hypokalemia and hypomagnesemia.
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Use cautiously with diabetes or thyrotoxicosis, hepatic or renal impairment, sick sinus syndrome, recent MI, pregnancy, lactation.
Available Forms
Tablets—80, 120, 160, 240 mg; injection—15 mg/mL
Dosages
Adults
Initial dose, 80 mg PO bid. Adjust gradually, every 3 days, until appropriate response occurs; may require 240–320 mg/day (Betapace); up to 120 mg bid (Betapace AF). Use IV dose as a substitute for oral therapy when patient is unable to take drug orally. Initially, 75 mg IV over 5 hours twice a day; may be increased in increments of 75 mg/day every 3 days. Range: 225–300 mg once or twice a day for ventricular arrhythmias; 112.5 mg once or twice a day for AF. Monitor QT interval. Switch to oral form as soon as possible. Converting between oral and IV doses: 80 mg oral–75 mg IV; 120 mg oral–112.5 mg IV; 160 mg oral–150 mg IV
Pediatric patients older than 2 yr with normal renal function
30 mg/m2 PO tid. Can titrate to a maximum of 60 mg/m2 PO tid. Allow 36 hr between increments.
Pediatric patients younger than 2 yr
See manufacturer’s instructions.
Geriatric patients or patients with renal impairment
Betapace
For CrCl less than 10 mL/min, individualize dose based on response. See table below for dosing intervals.
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