Actions and Spectrum: 

Spectrum of activity: 

sotalol has a broad spectrum of activity and is effective in treating both supraventricular and ventricular arrhythmias. It can be used to treat a variety of arrhythmias, including: 

• Atrial fibrillation/flutter: Sotalol is effective in treating atrial fibrillation and flutter by controlling the heart rate and restoring normal sinus rhythm. 
• Ventricular arrhythmias: Sotalol can also treat ventricular arrhythmias, including ventricular tachycardia and ventricular fibrillation. 

Actions: 

sotalol works by blocking beta-adrenergic receptors in the heart, which reduces the sympathetic nervous system’s activity and decreases the heart rate and contractility. This action also helps to decrease the oxygen demand of the heart muscle, making it useful in the treatment of angina. 

sotalol also prolongs the cardiac action potential duration by blocking potassium channels, which results in increased refractoriness of the cardiac tissue. This effect is responsible for the drug’s class III antiarrhythmic properties, making it effective in treating atrial and ventricular arrhythmias. 

 

DRUG INTERACTION

Contraindicated  

Serious Use Alternative  

Monitor Closely  

Minor  

Frequency defined 

>10% 

Dizziness (20%) 

Dyspnea (21%) 

Fatigue (20%) 

Chest pain (16%) 

Bradycardia (16%) 

Palpitation (14%) 

Lightheadedness (12%) 

Weakness (13%) 

1-10% 

Headache (8%) 

Edema (8%) 

Sleep disturbances (8%) 

Diarrhea (7%) 

Abnormal ECG (7%) 

Nausea/vomiting (10%) 

Extremity pain (7%) 

Mental confusion (6%) 

Hypotension (6%) 

Congestive heart failure (5%) 

Syncope (5%) 

Itching/rash (5%) 

Black Box Warning: 

The black box warning for sotalol is related to its potential to cause a type of abnormal heart rhythm called torsades de pointes. This is a serious condition that can lead to fainting or sudden cardiac arrest. 

 

Contraindication / Caution: 

Contraindications: 

• Hypersensitivity to sotalol or any of its components 
• Sinus bradycardia (slow heart rate) 
• Second or third-degree AV block (a type of heart block) 
• Congestive heart failure 
• Cardiogenic shock 
• Hypokalemia (low potassium levels in the blood) 

Caution: 

• Patients with asthma or other respiratory conditions may be at increased risk for bronchospasm 
• Patients with a history of prolonged QT syndrome or other arrhythmias should be closely monitored 
• Use caution in patients with renal impairment, as sotalol is primarily excreted by the kidneys 
• Use caution in patients with liver impairment, as sotalol is metabolized in the liver 
• Use caution in elderly patients, as they may be more sensitive to the effects of sotalol 

Pregnancy warnings:   

Pregnancy category: N/A

Lactation: Excreted into human milk is known

Pregnancy Categories:     

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester.

Category B: There were lack of studies on pregnant women and no evidence of risk to the foetus in animal experiments.

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.

Category N: There is no data available for the drug under this category

Pharmacology: 

sotalol is a medication used to treat certain types of irregular heartbeats, such as atrial fibrillation, atrial flutter, and ventricular tachycardia. It belongs to the class of drugs known as beta-blockers with additional class III antiarrhythmic properties. 

Pharmacodynamics: 

sotalol involves its ability to block beta-adrenergic receptors, which are responsible for regulating the heart’s rhythm and rate. By blocking these receptors, sotalol reduces the heart’s sensitivity to adrenaline and other stress hormones, which can cause irregular heartbeats. 

Additionally, sotalol blocks potassium channels in the heart, which prolongs the action potential duration and the refractory period. This results in the suppression of early and delayed after-depolarizations and decreases the risk of ventricular arrhythmias. 

Pharmacokinetics: 

Absorption 

sotalol is well absorbed orally, with peak plasma concentrations occurring within 2-3 hours of administration. The bioavailability of sotalol after oral administration is about 90%. 

Distribution 

sotalol is widely distributed throughout the body, with a volume of distribution of approximately 2-4 L/kg. It is highly protein-bound (greater than 90%) in the plasma. 

Metabolism 

sotalol is primarily metabolized in the liver, through N-dealkylation and hydroxylation. The major metabolite of sotalol is N-desethylsotalol, which is also pharmacologically active. 

Elimination and Excretion 

sotalol is excreted in the urine (approximately 80-90% of a dose) and feces (approximately 10-20% of a dose). The elimination half-life of sotalol is approximately 12 hours in patients with normal renal function. 

 

Administration: 

sotalol is a medication that is primarily used to treat certain heart rhythm disorders, such as atrial fibrillation and ventricular arrhythmias. It is typically administered orally in the form of a tablet or solution. 

The recommended dosage of sotalol may vary depending on the individual patient and the condition being treated. 

Patient information leaflet 

Generic Name: sotalol 

Why do we use sotalol? 

sotalol is primarily used to treat certain heart rhythm disorders, such as atrial fibrillation and ventricular arrhythmias. These conditions occur when the electrical impulses that regulate the heartbeat become irregular, causing the heart to beat too quickly, too slowly, or in an erratic pattern. sotalol helps to regulate the heartbeat by blocking certain electrical signals in the heart, which can help to restore a normal heart rhythm.