Arrhythmias, Cardiac arrhythmias, Supraventricular and ventricular arrhythmias
Anti adrenergic agent (Beta blockers)
Sotalol is a non-cardioselective beta-blocker. It increases sinus cycle length, slows heart rate, decreases AV nodal conduction and increases AV nodal refractoriness. It also prolongs AV monophasic action potentials. However, it lacks intrinsic sympathomimetic and membrane-stabilising properties.
Supraventricular and ventricular arrhythmias: Initial: 80 mg/day in 1 -2 divided doses, increase gradually every 2-3 days. Usual: 160-320 mg/day in 2 divided doses. Max: 640 mg/day. Life-threatening ventricular arrhythmias: 480-640 mg/day. Acute arrhythmias: 20-120 mg, may repeat 6 hrly if needed. For programmed electrical stimulation (to test antiarrhythmic efficacy): Initial: 1.5 mg/kg, then 0.2-0.5 mg/kg/hr infusion
ln combined therapy, clonidine should not be discontinued unitil several days after withdrawal of Sotalol. Use with great caution with drugs that also prolong OT interval, e.g. disopyramide, amiodarone, Class I antiarrhythmic agents, calcium antagonists of the verapamil type or tricyclic antidepressants. Interactions also occur with phenothiazines, terfenadine, astemizole and diltiazem. Concomitant use of reserpine, guanethidine, or alpha methyldopa requires close monitoring for evidence of hypotension and/or marked bradycardia, syncope. Hypoglycemia may occur and the dosage of insulin or antidiabetic drugs may require adjustment.
Bronchial asthma or history of COPD, sick sinus syndrome, symptomatic sinus bradycardia, cardiogenic shock. 2nd and 3rd degree AV block, untreated phaeochromocytoma, torsades de pointes, congenital or acquired long QT syndromes, uncontrolled cardiac failure, cardiogenic shock, metabolic acidosis, hypotension, severe peripheral arterial disease, Raynaud's disease, anaesthesia that causes myocardial depression. Renal impairment (CrCI <10 mL/min). Concomitant use with Ca channel blockers (e.g. verapamil and diltiazem).
Dyspnea, Dizziness, Fatigue, Bradycardia, Chest pain, Palpitation, Weakness, Lightheadedness, Nausea/vomiting, Edema, Headache, Sleep disturbances, Abnormal ECG, Diarrhea, Extremity pain, Hypotension, Mental confusion, Congestive heart failure, ltching/rash, Syncope, Anxiety, Depression, Torsades de pointes or new ventricular tachycardia / fibrillation in patients with supraventricular arrhythmia, Peripheral vascular disorders, Impotence, Proarrhythmic effect, Torsades de pointes with history of sustained ventricular tachycardia, Catechol hypersensitivity after abrupt withdrawal, Increased insulin requirement in diabetics
Pregnancy Category- D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Overdosage causes excessive bradycardia and hypotension; congestive heart failure, bronchospasm and hypoglycemia.
Store in a cool and dry place, protected from light.
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