Sotalol [injection $8.27; oral 5 cents] ADMINISTRATION ROUTES:
ALTERNATIVE NAMES: Sotalol, Sotacor
ICU INDICATIONS: 1. acutetreatmentandpreventionofsupraventriculartachycardia
PRESENTATION AND ADMINISTRATION:
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)
Individualise dose. 0.5 to 1.5mg/kg (20 – 120mg). Repeat 6 hourly if necessary. Usual maximum daily dose 320mg.
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
<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
384DOSAGE IN PAEDIATRICS:
0.5 – 2mg/kg over 10 minutes 6 hourly
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
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
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.
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
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.
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
Body as a Whole:
Bradycardia, Ventricular tachycardia, Cold extremities, Hypotension, Leg pain
Dizziness, Vertigo, Light-headedness