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Sotalol is a medication used to treat abnormal heart rhythms. The U.S. Food and Drug Administration (FDA) advises that sotalol only be used for serious abnormal heart rhythms, because its prolongation of the QT interval carries a small risk of life-threatening polymorphic ventricular tachycardia known as torsade de pointes.
Sotalol is a non-selective competitive beta-adrenergic receptor blocker that also exhibits Class III antiarrhythmic properties.
Sotalol was discovered in 1960, became widely used in the 1980s, and its function as an antiarrhythmic drug was discovered soon after.
Contents
1 Medical uses
2 Contraindications
3 Adverse effects
4 Mechanisms of action
4.1 Beta-blocker action
4.2 Type III antiarrhythmic action
5 History
6 Brand names
7 References
Medical uses
According to the U.S. FDA, sotalol can be validly used to maintain a normal heart rhythm in people with life-threatening ventricular arrhythmias (e.g., ventricular tachycardia ), or very symptomatic atrial fibrillation or flutter.
Contraindications
According to the FDA, sotalol should not be used in people with a waking heart rate lower than 50 beats per minute.
Since sotalol is removed from the body through the kidneys, it should not be used in people with a creatinine clearance rate below 40 mL/min.
Since sotalol prolongs the QT interval, the FDA recommends against using it in conjunction with other medications that prolong the QT interval.
Some evidence suggests that sotalol should be avoided in the setting of heart failure with a reduced ejection fraction (resulting in the heart squeezing little blood out into the circulation with each pump) due to an increased risk of death.
Adverse effects
Over 10% of oral sotalol users experience fatigue, dizziness, lightheadedness, headache, weakness, nausea, shortness of breath, bradycardia (slow heart rate), a sensation of the heart beating too hard, fast, or irregularly, or chest pain. Higher doses of sotalol increase the risk for all of these possible side effects.
In rare cases, the QT prolongation caused by sotalol can lead to the development of life-threatening torsade de pointes (TdP) polymorphic ventricular tachycardia. Across several clinical trials, 0.6% of oral sotalol patients with supraventricular abnormal heart rhythms (such as atrial fibrillation) developed TdP.
Mechanisms of action
Beta-blocker action
Sotalol non-selectively binds to both β1- and β2-adrenergic receptors preventing activation of the receptors by their stimulatory ligand ( catecholamines ).
Type III antiarrhythmic action
Sotalol also acts on potassium channels and causes a delay in relaxation of the ventricles. This increase in the period before a new signal for contraction is generated, helps to correct arrhythmias by reducing the potential for premature or abnormal contraction of the ventricles but also prolongs the frequency of ventricular contraction to help treat tachycardia.
History
Sotalol was first synthesized in 1960 by A. A. Larsen of Mead-Johnson Pharmaceutical.
Brand names
Trade names for Sotalol include Betapace and Betapace AF ( Berlex Laboratories ), Sotalex and Sotacor ( Bristol-Myers Squibb ), and Sotylize ( Arbor Pharmaceuticals ).

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