sotaloli

Sotalol is a nonselective beta-adrenergic blocker with additional class III antiarrhythmic properties. It reduces heart rate and AV conduction and, through blockade of potassium channels, prolongs the cardiac action potential. It is used to treat certain supraventricular and ventricular arrhythmias and is available in oral and intravenous forms.

It exerts beta-blockade on beta-1 and beta-2 receptors, lowering heart rate and slowing AV conduction, while its class III action blocks cardiac potassium channels, prolonging repolarization and the QT interval. The combination helps suppress abnormal electrical activity but raises the risk of torsades de pointes, particularly with electrolyte disturbances or bradycardia.

Medical uses: Sotalol is used to treat recurrent ventricular tachycardia and to maintain sinus rhythm in atrial fibrillation or flutter. Brand names Betapace and Betapace AF are common; Betapace AF is approved specifically for atrial fibrillation/flutter, while other forms are used for ventricular arrhythmias.

Dosing and administration: Initiation and dose adjustment typically occur in a hospital setting with ECG monitoring due to QT-risk. Oral doses commonly range from 80 to 320 mg per day, divided; renal impairment requires dose modification. An intravenous form is available for acute management in appropriate settings.

Safety and monitoring: Side effects include bradycardia, fatigue, hypotension, and bronchospasm from nonselective beta-blockade. The major safety concern is QT prolongation and torsades de pointes, worsened by electrolyte disturbances or other QT-prolonging drugs. It is contraindicated in significant bradycardia, higher-degree AV block, and decompensated heart failure, and caution is advised in asthma or COPD with bronchospasm and in renal impairment. Regular ECG and electrolyte monitoring are recommended during initiation and dose changes.