Sotalol Hydrochloride ๐
๐ Sotalol is a non-selective beta-blocker that also acts as a Class III antiarrhythmic at higher doses by prolonging cardiac action potentials.
Its dual action makes it useful in arrhythmia management, but it carries important safety concerns (notably QT prolongation).
Always check the BNF link here.
โ๏ธ Mechanism of Action
- Blocks ฮฒ1 & ฮฒ2 receptors โ โ heart rate, โ AV conduction.
- Class III action โ prolongs atrial & ventricular action potential duration.
- Can suppress ectopic activity but risks torsades if QT is prolonged.
๐ซ Sotalol in Atrial Fibrillation
- Starting dose: 40 mg BD, titrated up to 160 mg BD.
- Used in paroxysmal AF, but not superior to bisoprolol in persistent AF.
- Monitor ECG: risk of QT prolongation โ torsades de pointes.
๐ Indications / Dosing
- Ventricular arrhythmias, AF, SVT: 40 mg BD, โ to 160 mg BD orally.
- Higher doses may be required for VT suppression (specialist use only).
๐ Dose Range (check BNF/datasheet)
| Name | Starting Dose | Frequency | Route |
|---|
| Sotalol | 40โ160 mg | BD | PO |
โ ๏ธ Side Effects
- QT prolongation โ torsades de pointes (life-threatening).
- Bradycardia, hypotension.
- Bronchospasm (ฮฒ2 blockade), headache, fatigue.
๐ Cautions
- Correct hypokalaemia & hypomagnesaemia before starting.
- Monitor ECG at initiation & dose adjustments.
๐ซ Contraindications
- Asthma, bronchospasm, obstructive airway disease.
- 2nd/3rd degree AV block, HR <60/min, SBP <100 mmHg.
- Severe peripheral vascular disease, LV failure, uncontrolled CCF.
๐ Interactions
- As per ฮฒ-blockers (e.g. additive bradycardia with digoxin, amiodarone).
- Avoid with Verapamil (risk of severe bradycardia & AV block).
๐ References
๐ก Exam Pearls
- Think: โBeta-blocker + Class IIIโ = dual mechanism.
- Key OSCE safety check: baseline ECG and electrolytes before starting.
- More useful in ventricular arrhythmias than in long-term AF control.
