The recommended starting dose for life-threatening ventricular arrhythmias is 80 mg taken orally twice daily (BID). The dose may be increased by increments of 80 mg/day every three days if the corrected QT interval (QTc) is less than 500 msec
Patients should be monitored until steady-state levels are achieved. The therapeutic dose is usually obtained at a total daily dose of 160-320 mg/day divided into BID or TID dosing
In refractory cases of life-threatening arrhythmias, doses of 480-640 mg/day have been utilized
For atrial fibrillation/flutter, the starting dose is also 80 mg taken orally BID. The dose may be increased by increments of 80 mg/day every three days if the QTc is less than 500 msec. The typical maintenance dose for atrial fibrillation/flutter is 120 mg taken orally BID
It is important to note that initiation of sotalol in patients with creatinine clearance less than 40 mL/min or QTc greater than 450 msec is contraindicated due to the increased risk of adverse effects
IV sotalol as a substitute for oral sotalol
When using IV sotalol as a substitute for oral sotalol, it is important to match the exposure to the drug as closely as possible
For an 80 mg oral dose of sotalol, substitute with 75 mg IV
For a 120 mg oral dose of sotalol, substitute with 112.5 mg IV
For a 160 mg oral dose of sotalol, substitute with 150 mg IV
For a loading dose of IV sotalol, it should be infused over 1 hour. The loading dose is typically higher than the maintenance dose and is given to rapidly achieve therapeutic levels of the drug
sotalol IV 0-80 mg
CrCl (>90 mL/min): 60 mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (60-90 mL/min): 82.5 mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (30-60 mL/min): 75 mg IV; maintain 6 hours gap for first PO dose (24 hours oral dose)
CrCl (10-30 mL/min): 75 mg IV; maintain 12 hours gap for first PO dose (48 hours oral dose)
sotalol IV 0-120 mg
CrCl (>90 mL/min): 90 mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (60-90 mL/min): 125 mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (30-60 mL/min): 112.5 mg IV; maintain 6 hours gap for first PO dose (24 hours oral dose)
CrCl (10-30 mL/min): 112.5 mg IV; maintain 12 hours gap for first PO dose (48 hours oral dose)
lower dose Reinitiating from 120-80 mg
If the QTc interval exceeds 500 ms or increases 20% from baseline when starting a 120-mg oral dose, discontinue the drug and consider a lower dose
CrCL (≥60 mL/min): to reinitiate maintain gap for 1 days
CrCL (≥30-<60 mL/min): to reinitiate maintain gap for 3 days
CrCL (≥10-<30 mL/min): to reinitiate maintain gap for 7 days
sotalol IV escalation 80-120 mg
CrCl (>90 mL/min): 75 mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (60-90 mL/min): 82.5mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (30-60 mL/min): 82.5 IV; maintain 6 hours gap for first PO dose (24 hours oral dose)
CrCl (10-30 mL/min): 82.5 IV; maintain 12 hours gap for first PO dose (48 hours oral dose)
sotalol IV escalation 120-160 mg
CrCl (>90 mL/min): 90 mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (60-90 mL/min): 105 mg IV; maintain 4 hours gap for first PO dose (12 hours oral dose)
CrCl (30-60 mL/min): 105 mg IV; maintain 6 hours gap for first PO dose (24 hours oral dose)
CrCl (10-30 mL/min): 105 mg IV; maintain 12 hours gap for first PO dose (48 hours oral dose)
Indicated for Arrhythmias, epistaxis, PMS
1-4 gm of capsules orally three times a day
Or
10-15 gm of crushed herb every day orally divided three times a day
Or
5-8 gm of liquid extract every day orally in divided three times a day
Or
3-5 gm applied as topically
For brewed tea
Three times a day following meals and steep, take 1 teaspoon of leaves and blossoms in 8 ounces of boiling water For leaf/flower
Extract: 160 to 900 mg daily orally divided two and three times a day
Powder: 200 to 500 mg orally three times a day
Tincture: 20 drops orally two and three times a day For fruit
Dried powder: 300 to 1000 mg orally three times a day
Liquid extract: 0.5 to 1 ml orally three times a day
Tincture: 1 to 2 ml orally three times a day
Syrup: 1 teaspoon orally three times a day
Cardiac Glycosides
Take a dose of 600 mg orally daily
Tincture: take a dose of 6 g daily orally divided three times a day
Liquid extract: take a dose of 600 mg daily orally divided three times a day
Dried extract: take a dose 150 mg orally daily
Take a dose of 100 to 600 mg orally each 4 to 6 hours
Start with dose of 200 mg and titrate to desired effect
Daily dose should not be more than 3 to 4 g
for Extended Release:
Take a dose of 324 to 648 mg (as gluconate form) orally each 8 to 12 hours OR
Intravenous:
Dose of 800 mg of quinidine gluconate diluted up to 50 ml and administer at a rate not more than 1 ml/min
Rapid digitalization with an oral loading dose of 600 mcg, which after 4-6 hours is followed by 400 mcg, followed by 200 mcg for every 4 -6 hours if necessary, depending on the patient's condition and slow digitalization with an oral dose of 200 mcg twice daily for four days
The maintenance dose is 50 to 300 mcg once every 24 hours, whereas the usual dose is 150 mcg every 24 hours
Dose Adjustments
Renal dose adjustments In renal impairment, if the CrCl is less than or below 10 mL/min, the recommended dose is 50% or 75% of the usual dose
Butidrine is a naphthalene methanol derivative with β-adrenolytic, antiarrhythmic, and local anesthetic properties hence it is used in treating arrhythmias
Indicated for Supraventricular arrhythmias Administer 50 mg intravenously over a minimum of five minutes Alternatively, the medication can be delivered through intravenous infusion, intramuscular injection, or oral administration
Indicated for ventricular arrhythmias Administer 50 mg intravenously over a minimum of five minutes Alternatively, the medication can be delivered through intravenous infusion, intramuscular injection, or oral administration
in patients with normal renal function which is equivalent to an initial total daily dose of 90 mg/m2 for adults
This initial dose can be titrated up to a maximum of 60 mg/m2 TID, which is equivalent to a total daily dose of 320 mg for adults
The titration should be guided by clinical response, heart rate, and corrected QT interval (QTc), with increased dosing preferably carried out in the hospital
It is important to allow at least 36 hours between dose increments to attain steady-state plasma concentrations of the drug in patients with age-adjusted normal renal function
Steady-state levels of sotalol are necessary to achieve a consistent therapeutic effect and to avoid potential adverse effects associated with rapid dose increases
Take dose of 30 mg/kg daily orally given in 5 divided doses
Take dose of 2 mg/kg orally of quinidine sulfate and test dose should not be more than 200 mg
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