Sotalol (Intravenous)

Used to treat patients with rapid heartbeats, Sotalol is a beta blocker and works by influencing the body's response to nerve impulses.

Overview

Sotalol is a prescription only medication that is used to treat patients with irregular or overly rapid heartbeats. The intravenous version is used in patients whose conditions have become particularly life-threatening or serious.

Sotalol is part of a family of drugs called the beta blockers, which work by influencing the body's response to nerve impulses in the heart. This then controls the heartbeat, returning it to a regular and slower pace.

An irregular or fast heartbeat occurs when there is a problem with the electrical system in the heart. This system is what tells the heart when to beat and how to pump blood around the body. Referred to medically as arrhythmia, the condition of a rapid or irregular heartbeat can cause a range of symptoms in the patient. These include dizziness, feeling out of breath, palpitations (a fluttering or pumping sensation in the chest), excessive tiredness and the loss of consciousness.

When these symptoms become severe, it could be a sign that the irregular heartbeat is leading to more serious problems, and this is when a beta blocker like sotalol is then prescribed. Disorders of the atrium (the part of the heart that enables blood to flow into it) can be fatal if left untreated.

The intravenous version of sotalol does not have any brand names in the United States, so it will be sold under this generic name only.

Type of medicine

  • Solution, to be administered as an injection by a doctor

Conditions treated

  • Arrhythmia
  • Irregular heartbeat (serious or life-threatening)
  • Rapid heartbeat (serious or life-threatening)

Side effects

As your body gets used to having the substance in its system, you may experience various side effects. Most of these symptoms are nothing to worry about and are not usually a cause for medical concern. However, there are some you should report to the doctor straight away, as they may be a sign of an adverse reaction to sotalol.

The following side effects are considered normal and are not normally a cause for medical intervention. However, if they persist, you should notify your medical professional for advice:

  • Blurry or temporarily poor vision
  • Pain or tightness in the chest
  • Confusion or disorientation
  • Difficulty breathing
  • Faintness, dizziness
  • Light-headedness when getting up from a sitting or lying position
  • Nausea or vomiting
  • Excess sweating
  • Swelling in various areas of the body, such as the hands, feet, face or lower legs
  • Excessive tiredness or weakness
  • Stomach pains or cramps
  • General aches and pains in the body
  • Tingling or numb feeling in the extremities
  • Double vision
  • Feeling too hot
  • Lack of alertness
  • Slurred speech or difficulty forming a coherent sentence
  • Dilated veins in the neck
  • Persistent cough or croaky voice
  • Headache
  • Paralysis in the legs, arms or face
  • Pain when passing urine
  • Difficulty passing urine
  • Unexplained buzzing or ringing in the ears
  • Pain and swelling in the joints
  • Irregular breathing
  • Unexplained weight gain
  • Rapidly trying to catch a breath
  • Pounding in the head or ears
  • Nervousness or anxiety
  • Red spots on the skin

Dosage

The dosage set of sotalol will often depend on a number of factors, such as your tolerance to the drug, the seriousness of your condition and, if you are a child, your body weight.

The initial dosage in most cases is 112.5 mg by injection once or twice daily. After this, a maintenance dose of 112.5 mg to 150 mg by injection once or twice daily is usually set.

Doctors will check the baseline QT interval before beginning the treatment. If it is less than 450 milliseconds, the treatment can start. However, for frequencies greater than this, the IV treatment must not start. The patient's QT levels should be monitored throughout the treatment after the completion of each infusion. The dose should be reduced if the QT level becomes greater than 500 milliseconds. Alternatively, the treatment should be stopped.

Major drug interactions

Before you start a treatment of sotalol, your doctor will need to know your full medical history, including any other drugs you have taken or may currently be taking. There are certain drugs that can react with sotalol when taken at the same time, causing unpleasant and even dangerous side effects. There are more than 1,000 drugs that can react with sotalol on some level - with side effects ranging from mild to severe. However, there are 249 of these drugs that are unsafe to take at the same time as sotalol, as they can cause a major reaction. These drugs are listed below:

  • abarelix
  • acetaminophen, propoxyphene
  • adenosine
  • albuterol
  • albuterol, ipratropium
  • alfuzosin
  • aminophylline
  • aminophylline, amobarbital, ephedrine
  • aminophylline, ephedrine, guaifenesin, phenobarbital
  • aminophylline, ephedrine, phenobarbital, potassium iodide
  • aminophylline, guaifenesin
  • amiodarone
  • amitriptyline
  • amitriptyline, chlordiazepoxide
  • amitriptyline, perphenazine
  • amoxapine
  • amoxicillin, clarithromycin, lansoprazole
  • amoxicillin, clarithromycin, omeprazole
  • anagrelide
  • apomorphine
  • arbutamine
  • arformoterol
  • arsenic trioxide
  • artemether, lumefantrine
  • articaine, epinephrine
  • asenapine
  • aspirin, caffeine, propoxyphene
  • astemizole
  • atazanavir
  • atazanavir, cobicistat
  • atomoxetine
  • azithromycin
  • azithromycin, trovafloxacin
  • bedaquiline
  • bepridil
  • bisacodyl, sodium biphosphate, sodium phosphate
  • bitolterol
  • bosutinib
  • budesonide, formoterol
  • bupivacaine, epinephrine
  • cabozantinib
  • ceritinib
  • chloroquine
  • chlorothiazide, methyldopa
  • chlorpheniramine, epinephrine
  • chlorpromazine
  • ciprofloxacin
  • cisapride
  • citalopram
  • clarithromycin
  • clofazimine
  • clomipramine
  • clozapine
  • codeine, phenylephrine, promethazine
  • codeine, promethazine
  • crizotinib
  • cytarabine liposomal, daunorubicin liposomal
  • dasatinib
  • daunorubicin
  • daunorubicin liposomal
  • degarelix
  • desipramine
  • deutetrabenazine
  • dextromethorphan, promethazine
  • dextromethorphan, quinidine
  • diltiazem
  • diltiazem, enalapril
  • disopyramide
  • dofetilide
  • dolasetron
  • doxepin
  • doxepin topical
  • doxorubicin
  • doxorubicin liposomal
  • dronedarone
  • droperidol
  • droperidol, fentanyl
  • dyphylline
  • dyphylline, ephedrine, guaifenesin, phenobarbital
  • dyphylline, guaifenesin
  • efavirenz
  • efavirenz, emtricitabine, tenofovir
  • eliglustat
  • emtricitabine, lopinavir, ritonavir, tenofovir
  • ephedrine, guaifenesin, theophylline
  • ephedrine, hydroxyzine, theophylline
  • ephedrine, phenobarbital, potassium iodide, theophylline
  • ephedrine, phenobarbital, theophylline
  • epinephrine
  • epinephrine, etidocaine
  • epinephrine, lidocaine
  • epinephrine, prilocaine
  • epirubicin
  • eribulin
  • erythromycin
  • erythromycin, sulfisoxazole
  • escitalopram
  • ezogabine
  • fingolimod
  • flecainide
  • fluconazole
  • fluoxetine
  • fluoxetine, olanzapine
  • fluphenazine
  • fluticasone, salmeterol
  • fluticasone, umeclidinium, vilanterol
  • fluticasone, vilanterol
  • formoterol
  • formoterol, glycopyrrolate
  • formoterol, mometasone
  • gatifloxacin
  • gemifloxacin
  • glycopyrrolate, indacaterol
  • goserelin
  • granisetron
  • grepafloxacin
  • guaifenesin, oxtriphylline
  • guaifenesin, theophylline
  • halofantrine
  • haloperidol
  • halothane
  • histrelin
  • hydrochlorothiazide, methyldopa
  • hydroxychloroquine
  • hydroxyzine
  • hyoscyamine, methenamine, methylene blue, phenyl salicylate, sodium biphosphate
  • hyoscyamine, methenamine, methylene blue, sodium biphosphate
  • ibutilide
  • idarubicin
  • iloperidone
  • imipramine
  • indacaterol
  • inotuzumab ozogamicin
  • isoetharine
  • ivabradine
  • ketoconazole
  • lapatinib
  • lenvatinib
  • letrozole, ribociclib
  • leuprolide
  • leuprolide, norethindrone
  • levalbuterol
  • levofloxacin
  • levomethadyl acetate
  • lithium
  • lomefloxacin
  • lopinavir, ritonavir
  • magnesium sulfate, potassium sulfate, sodium sulfate
  • maprotiline
  • mefloquine
  • meperidine, promethazine
  • mesoridazine
  • metaproterenol
  • methacholine
  • methadone
  • methenamine, sodium biphosphate
  • methotrimeprazine
  • methyldopa
  • midostaurin
  • mifepristone
  • mirtazapine
  • mixed grass pollens allergen extract
  • moxifloxacin
  • netupitant, palonosetron
  • nilotinib
  • norfloxacin
  • ofloxacin
  • olodaterol
  • olodaterol, tiotropium
  • ondansetron
  • osimertinib
  • oxaliplatin
  • oxtriphylline
  • paliperidone
  • palonosetron
  • panobinostat
  • papaverine
  • pasireotide
  • pazopanib
  • pentamidine
  • perflutren
  • perphenazine
  • phenylephrine, promethazine
  • pimavanserin
  • pimozide
  • pirbuterol
  • polyethylene glycol 3350 with electrolytes
  • posaconazole
  • potassium iodide, theophylline
  • probucol
  • procainamide
  • prochlorperazine
  • promazine
  • promethazine
  • propafenone
  • propoxyphene
  • protriptyline
  • pseudoephedrine, terfenadine
  • quetiapine
  • quinidine
  • quinine
  • racepinephrine
  • ragweed pollen allergen extract
  • ranolazine
  • ribociclib
  • rilpivirine
  • risperidone
  • ritodrine
  • romidepsin
  • salmeterol
  • saquinavir
  • sertraline
  • sevoflurane
  • sodium biphosphate, sodium phosphate
  • solifenacin
  • sorafenib
  • sparfloxacin
  • sunitinib
  • tacrolimus
  • tamoxifen
  • telavancin
  • telithromycin
  • terbutaline
  • terfenadine
  • tetrabenazine
  • theophylline
  • thioridazine
  • timothy grass pollen allergen extract
  • tizanidine
  • toremifene
  • trandolapril, verapamil
  • trazodone
  • trifluoperazine
  • triflupromazine
  • trimipramine
  • triptorelin
  • umeclidinium, vilanterol
  • valbenazine
  • vandetanib
  • vardenafil
  • vasopressin
  • vemurafenib
  • venlafaxine
  • verapamil
  • voriconazole
  • ziprasidone

Warnings

Other diseases and conditions

Your doctor will also ask you about any other conditions you may suffer from before administering sotalol via the intravenous route. This is because it may not be safe to take the drug if you have various other conditions; it could end up aggravating these conditions; likewise, any drugs taken to treat these conditions may impair the effectiveness of sotalol to treat your irregular heartbeat. Tell your doctor about any of the following conditions:

Alcohol

Alcohol has a moderate interaction with sotalol, meaning that it could have serious effects if the two are consumed together. If you are being treated with intravenous sotalol, it is not recommended that you consume alcohol throughout the entire treatment. If you do consume alcohol, you are likely to experience unpleasant side effects such as headaches, dizziness, light-headedness, fainting, and a change in the rate of your pulse. Alcohol can also increase the risk of developing low blood pressure when you are taking sotalol, which may cause you to feel particularly faint and nauseous.

High cholesterol

Beta blockers may alter the levels of serum in your body, which can lead to higher cholesterol levels in patients taking sotalol. Speak to your doctor if you have a history of high cholesterol, or if you think you may be particularly vulnerable to developing the condition. Your doctor will be able to offer you advice on how to prevent the condition developing, including dietary alterations. If the problem is deemed too severe, another medication or treatment form may be recommended.

Multi-vitamins with minerals

If you are taking any vitamins or minerals as supplements, you should consult your doctor for advice. Multi vitamins with minerals can impair the effects of sotalol. You may still be able to take both substances; however, you will usually need to separate the administrations of both by at least two hours. If you notice any negative effects of taking sotalol, always mention whether you take any dietary supplements, as these may be impacting your medication or your condition.

Pregnancy and breast feeding

Compared with other similar drugs, sotalol has been considered to be relatively safe for use during pregnancy. However, studies have found that there is a significant risk (between three to five percent) of the development of polymorphic or torsade de pointes tachycardia. The drug is recommended for use only in the latter stages of pregnancy and when the benefit outweighs the risk. Beta blockers such as sotalol can also cause reduced placental perfusion. This can result in fetal death in the most extreme circumstances. If you are taking this drug during the later stages of your pregnancy, you should stop taking it around two to three days before your due date. This will help to avoid the risk of uterine contractility.

There is only a very small risk of fetal toxicity, and this has been indicated in animals studies where the subjects were administered a rate 16 times that of the recommended dose for adult humans. To date, there have not been any adequate or conclusive studies of sotalol in pregnant humans.

Those that are breast-feeding may choose to stop their medication if the risk outweighs the benefit. There is evidence to suggest that sotalol can enter the breast milk and be consumed by a nursing baby. For breast-feeding women, there are other drugs that are preferred. Always ask your doctor for advice on sotalol usage during pregnancy and breast feeding.

Storage

Keep the solution for sotalol injections at room temperature and in a secure medical cabinet at all times. Once you need to use it, follow the instructions on the label for mixing the solution. Then, you should use it within 24 hours if you keep it refrigerated throughout this period. If the mixed solution is kept at room temperature, you must use it within four hours. Do not use solution that has not been stored properly, and do not use mixture that has been in injectable form for more than 24 hours. Failure to adhere to these instructions could result in danger to the patient, as well as the risk of the medicine becoming ineffective at regulating the heart rate.

Disposal

You should not attempt to flush this solution down a drain or toilet unless you are instructed to do so. You should properly and safely dispose of this product once you have finished using it. A trained medical professional will usually be in charge of disposing of sotalol, as it will usually be administered by a doctor, but ask your doctor for advice if you are in possession of unwanted or expired sotalol solution. To dispose of medication in the most responsible and safe way, you may be able to use an FDA take-back scheme. Visit the organization's website for further information about what schemes are available in your area.

Overview

Sotalol is a medication that is prescribed when various other treatments for irregular or rapid heartbeats have not worked, or when the conditions have become particularly severe. It is a very strong drug, particularly when administered in its intravenous form straight into the patient's vein. The injection enables the beta blocker to enter the bloodstream in as quick a time as possible, when the irregularities of the heartbeat have become threatening to the life of the patient.

This potentially life-saving drug has been proven effective in many cases of patients with abnormal heartbeat patterns, and is therefore a popular and often ideal choice for many sufferers. However, there have been found to be various risks and warnings associated with taking sotalol. First, there are a large number of drugs that react with sotalol, including many that are used to treat very common health problems. It is important to assess the patient's full prescription history before administering sotalol to ensure that there will be no major interactions.

There have also been various medical studies that have linked sotalol to high cholesterol levels, as well as being an aggravator for common conditions such as type two or type one diabetes, asthma and hypersensitivity. As a result, this can often rule out sotalol for a large number of people. A patient's medical history may mean that taking sotalol can actually be life-threatening. However, there are some times where the health benefits (e.g. saving the patient's life) will be deemed greater than the risk of contracting or aggravating another condition.

Provided all the usage and dosage instructions for sotalol are properly followed, and there are no drug or disease interactions, sotalol is generally a safe medication. It is always administered by a trained medical professional when used in its intravenous form; therefore, patients will be closely monitored throughout the treatment cycle for any detrimental effects. The treatment can then be discontinued immediately.

There is currently very limited data about how the drug affects children. Therefore, when administering the drug to those under the age of 12, monitoring should be extra strict and a lesser dose may be opted for. There is also limited data about how the drug affects those that are pregnant or breast-feeding, although it is generally advised that different medication should be taken unless the benefit outweighs the risk.