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CARDIOVASCULAR SYSTEM › BETA BLOCKING AGENTS › BETA BLOCKING AGENTS › Beta blocking agents, non-selective
sotalol
C07AA07
Forms & Strengths
- Oral Tablet: 80 mg, 120 mg, 160 mg, 240 mg
- Intravenous Solution: 150 mg/10 mL
Adult Dosing
- Ventricular Arrhythmias: Initial 80 mg orally twice daily, titrated up to 240-320 mg/day in 2-3 divided doses
- Atrial Fibrillation/Flutter Maintenance: Initial 80 mg orally twice daily, adjusted based on QT interval and CrCl
Pediatric Dosing
- Supraventricular and Ventricular Arrhythmias (Children > 2 years): Initial 30 mg/m2 orally three times daily (90 mg/m2/day), titrated up to 300 mg/m2/day
- Neonates and infants (< 2 years): Use reduced weight-based dosing with extreme caution regarding QTc prolongation
Indications
- Life-threatening ventricular arrhythmias
- Maintenance of normal sinus rhythm in patients with symptomatic atrial fibrillation/flutter
Mechanism of Action
- Non-selective beta-adrenergic receptor blocker (Class II antiarrhythmic)
- Prolongs repolarization and action potential duration in cardiac tissue via potassium channel blockade (Class III antiarrhythmic)
Contraindications
- Bronchial asthma or related bronchospastic conditions
- Sinus bradycardia (< 50 bpm), second- or third-degree AV block without a pacemaker
- Congenital or acquired long QT syndromes
- Cardiogenic shock and decompensated heart failure
- Baseline QTc interval > 450 ms (or > 500 ms with intraventricular conduction abnormality)
- CrCl < 40 mL/min (for AF/AFL indication)
Adverse Reactions
- Torsades de pointes and new or worsened ventricular arrhythmias (dose-dependent)
- Bradycardia, hypotension, and heart failure exacerbation
- Fatigue, dizziness, asthenia, and lightheadedness
- Dyspnea, bronchospasm
- Nausea, diarrhea
Drug Interactions
- QT-prolonging drugs (e.g., antipsychotics, macrolides, fluoroquinolones, other class I/III antiarrhythmics) increase risk of torsades de pointes
- Negative chronotropes (e.g., calcium channel blockers like verapamil/diltiazem, digoxin) increase risk of bradycardia and AV block
- Insulin and oral hypoglycemics; beta-blockers may mask symptoms of hypoglycemia
- Catecholamine-depleting drugs (e.g., reserpine) may produce excessive hypotension/bradycardia
Curated Content: Needs Vetting Before Put to Clinical Use