Drug reference

Sotalol

Beta Blocker · Antiarrhythmic

Also known as Sotalol hydrochloride

Beta BlockerAntiarrhythmicATC C07AA07

CDSCO approvedSchedule HATC C07AA07

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

[MHRA/CHM advice]. . Multiple sclerosis p. 893 and Nausea and labyrinth

FDA category + note

Top interactionssee all 12 →

AmisulprideContraindicatedDatabaseDDInter
AbarelixSevereDatabaseDDInter
AbirateroneSevereDatabaseDDInter
AdenosineSevereDatabaseDDInter

Mechanism

Sotalol is unique among beta blockers in possessing both Class II (non-selective β1 and β2 adrenergic blockade) and Class III (potassium channel blockade prolonging cardiac action potential duration) antiarrhythmic properties. The d-isomer provides the Class III K+ channel blocking effect, while the l-isomer provides the beta-blocking activity. This dual mechanism — slowing heart rate while prolonging repolarization — makes it effective for both atrial and ventricular arrhythmias, though the QT prolongation carries a 2-4% risk of torsades de pointes.

Indications

Maintain sinus rhythm post-cardioversion (if standard beta-blocker is not appropriate or ineffective)Symptomatic paroxysmal atrial fibrillation (if standard beta-blocker is not appropriate or ineffective)Ventricular tachyarrhythmiasAtrial fibrillationAtrial flutterHypertensionAnginaProphylaxis of myocardial infarctionPolymorphic ventricular tachycardia (VT)Some Wolff-Parkinson-White (WPW) arrhythmiasMaintaining sinus rhythm in atrial fibrillation (AF)Maintaining sinus rhythm in atrial flutter (AFl)

Dosing

Adult: . Changes, provides a list of signiﬁcant changes, dose changes, classiﬁcation changes, new names, and new preparations that have been incorporated into the BNF, as well as a list of preparations that have been discontinued and removed from the BNF.…

Pharmacokinetics

Half-life

8 h

Bioavailability

>80%

Protein binding

Not specified

Metabolism

Not specified

Excretion

70 ± 15%

Contraindications

Ventricular rate control in atrial fibrillation
Prolonged QT interval
Asthma
Peripheral vascular disease
Hypoglycemia

Side effects

Serious

Torsades de pointes (1.5–2% incidence, dose-dependent, especially with low serum K+ or renal dysfunction)
Fatigue (β adrenergic blockade effect)
Bronchospasm (β adrenergic blockade effect)
Hypotension (β adrenergic blockade effect)
Impotence (β adrenergic blockade effect)
Depression (β adrenergic blockade effect)
Aggravation of heart failure (β adrenergic blockade effect)
Worsening of symptoms due to peripheral vascular disease (β adrenergic blockade effect)
Masking of the symptoms of hypoglycemia in diabetic patients (β adrenergic blockade effect)
Dose-dependent Torsades de pointes