Sotalol

Sotalol [injection $8.27; oral 5 cents] ADMINISTRATION ROUTES:

PO, IV

ALTERNATIVE NAMES: Sotalol, Sotacor

ICU INDICATIONS: 1. acutetreatmentandpreventionofsupraventriculartachycardia

PRESENTATION AND ADMINISTRATION:

IV:

Injection ampoule (40mg/4ml solution) Add required dose to an appropriate volume of compatible IV fluid to prepare a solution with a concentration of 0.1-2mg/ml (see examples in table below). Infuse over 10 minutes.

Compatible with the following IV fluids: 0.9% sodium chloride 5% glucose Store at room temperature; if storage is necessary after dilution, refrigerate for no more than 24 hours.

PO: Tablets: Sotalol 80mg tablets (white), Sotalol 160mg (white)

DOSAGE:

IV:

Individualise dose. 0.5 to 1.5mg/kg (20 – 120mg). Repeat 6 hourly if necessary. Usual maximum daily dose 320mg.

PO:

Initially 80mg twice daily; may increase gradually to 240-320mg/day

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment [GFR (ml/min)]

Volume of Sotalol Injection

Diluent Volume

Total Volume

Sotalol Concentration

4ml

16ml

20ml

2mg/ml

4ml

36ml

40ml

1mg/ml

4ml

46ml

50ml

0.8mg/ml

4ml

96ml

100ml

0.4mg/ml

8ml

32ml

40ml

2mg/ml

8ml

72ml

80ml

1mg/ml

<10 10-20 >20-50 Dose in renal replacement therapy

Avoid or use with caution 25% of normal dose 50% of normal dose

CAPD HD CVVHDF

Avoid Avoid 25% of normal dose

Solatol

384DOSAGE IN PAEDIATRICS:

IV:

0.5 – 2mg/kg over 10 minutes 6 hourly

PO:

1-4mg/kg 8 -12 hourly

CLINICAL PHARMACOLOGY: Sotalol hydrochloride is an antiarrhythmic drug with Class II (beta-adrenoreceptor blocking) and Class III (cardiac action potential duration prolongation) properties.

CONTRAINDICATIONS: 1. sinusbradycardia, 2. heartblockgreaterthanfirstdegree, 3. cardiogenicshock, 4. overtcardiacfailure 5. asthma

WARNINGS

Proarrhythmia

Like other antiarrhythmic agents, sotalol can provoke new or worsened ventricular arrhythmias in some patients, including sustained ventricular tachycardia or ventricular fibrillation, with potentially fatal consequences General

Cardiac Failure

Sympathetic stimulation is necessary in supporting circulatory function in congestive heart failure, and beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure. Discontinuation of therapy

Discontinuation of therapy in a patient with coronary artery disease may lead to rebound angina, arrhythmia or myocardial infarction. Diabetes and Hypoglycemia Beta blockers may mask tachycardia occurring with hypoglycaemia.

Thyrotoxicosis

Beta-adrenergic blockade may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Abrupt withdrawal of beta blockade might precipitate a thyroid storm.

PRECAUTIONS Sotalol may aggravate peripheral circulatory disorders

Laboratory Tests:

No tests are required in addition to routine ICU tests

Drug/Laboratory Test Interactions:

The presence of sotalol in the urine may result in falsely elevated levels of urinary metanephrine when measured by fluorimetric or photometric methods.

Solatol

Version 30/08/2010

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Version 30/08/2010

IMPORTANT DRUG INTERACTIONS FOR THE ICU Class Ia antiarrhythmic drugs, such as disopyramide, quinidine and procainamide and other Class III drugs (e.g., amiodarone) are not recommended as concomitant therapy with Sotalol, because of their potential to prolong refractoriness leading to ventricular arrhythmia. Additive Class II effects would also be anticipated with the use of other beta-blocking agents concomitantly with Sotalol. Sotalol should be administered with caution in conjunction with calcium blocking drugs because of possible additive effects on atrioventricular conduction or ventricular function. Additionally, concomitant use of these drugs may have additive effects on blood pressure, possibly leading to hypotension Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine

ADVERSE REACTIONS

Body as a Whole:

Tiredness, Fatigue

Cardiovascular System:

Bradycardia, Ventricular tachycardia, Cold extremities, Hypotension, Leg pain

Respiratory System:

Wheeziness, Dyspnoea

Digestive System:

Diarrhoea, Nausea

Nervous System:

Dizziness, Vertigo, Light-headedness