Sotalol

Class III / Non-selective Beta Blocker·Cardiovascular - Antiarrhythmics

Maintenance of sinus rhythm in AF/AFL, suppression of VT

PBSCLASS IIISotacor, Solavert80 mg tabletS4+1

Max Dose

320 mg/day

Half-life

10–20 h

QTc Risk

HIGH

Renal Adj.

MANDATORY

Rapid Summary

Overview

Unique agent combining potent non-selective beta-blockade (Class II) with potassium channel blockade (Class III). Used for strict rhythm control in arrhythmias.

Maximum Dose

Max 320 mg/day (given in divided doses).

Clinical Focus

High risk of QT prolongation and Torsades de Pointes. Excreted 100% via kidneys; lethal if unadjusted in renal failure.

Bottom Line

Sotalol is a unique combined beta-blocker and Class III antiarrhythmic for AF and VT, but prolongs QTc and requires ECG monitoring with dose changes due to risk of Torsades de Pointes.

Formulation & Access

Brand Names

Sotacor, Solavert

Oral Routes

Tablets (80 mg, 160 mg).

Parenteral

Ampoule for IV use (Rare, highly specialised).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Maintenance of sinus rhythm in AF/AFL, suppression of VT.

Clinical Place

Used when a patient needs both rate and rhythm control, but requires perfect renal function and QT monitoring.

Quick reference

Class & Role

Class III / Non-selective Beta Blocker — Unique agent combining potent non-selective beta-blockade (Class II) with potassium channel blockade (Class III).

Route / Formulation

Tablets (80 mg, 160 mg). (Sotacor, Solavert)

Usual Dose & Max

Start PO 80 mg BD. Titrate slowly under ECG guidance to Max 160 mg BD (320 mg/day).

Key Indication Doses

AF Rhythm Control: Start PO 80 mg BD. Titrate slowly under ECG guidance to Max 160 mg BD (320 mg/day). Ventricular Arrhythmias: PO 80-160 mg BD. Renal Impairment: eGFR 30-60: Give dose OD. eGFR 10-30: Give dose every 48 hours. eGFR <10: CONTRAINDICATED.

Best Uses

Sotalol is a unique combined beta-blocker and Class III antiarrhythmic for AF and VT, but prolongs QTc and requires ECG monitoring with dose changes due to risk of Torsades de Pointes.

Avoid / Cautions

Severe asthma, baseline QTc > 450 ms, uncorrected hypokalemia, 2nd/3rd degree heart block, severe renal failure. Pregnancy Category C.

Key Risks

Cardiovascular: Dose-dependent QTc prolongation, Torsades de Pointes, profound bradycardia, heart failure exacerbation. Respiratory: Bronchospasm (non-selective beta blocker). Neurological: Fatigue, dizziness, sleep disturbances.

Key Interactions

Any other QT prolonging drugs (e.g., Macrolides, SSRIs, Antipsychotics) risk fatal arrhythmias. Non-DHP CCBs (Verapamil) risk asystole.

Monitoring

Baseline and ongoing ECG. Cease immediately if QTc > 500 ms. Do not start until baseline QTc is confirmed normal. Strict baseline and regular U&E (K+ and Mg2+ MUST be kept in the high-normal range) and eGFR.

Clinical Pearl

Sotalol has a dangerous paradox: its QT-prolonging effect is strongest when the heart rate is SLOW. This makes bradycardic patients exquisitely vulnerable to Torsades de Pointes.

Access

Sotacor, Solavert80 mg tablet

Brand: Sotacor, Solavert
Formulation: Tablets (80 mg, 160 mg)

Sotalol

Class III / Non-selective Beta Blocker·Cardiovascular - Antiarrhythmics

Maintenance of sinus rhythm in AF/AFL, suppression of VT

PBSCLASS IIISotacor, Solavert80 mg tabletS4+1

Max Dose

320 mg/day

Half-life

10–20 h

QTc Risk

HIGH

Renal Adj.

MANDATORY

Rapid Summary

Overview

Unique agent combining potent non-selective beta-blockade (Class II) with potassium channel blockade (Class III). Used for strict rhythm control in arrhythmias.

Maximum Dose

Max 320 mg/day (given in divided doses).

Clinical Focus

High risk of QT prolongation and Torsades de Pointes. Excreted 100% via kidneys; lethal if unadjusted in renal failure.

Bottom Line

Sotalol is a unique combined beta-blocker and Class III antiarrhythmic for AF and VT, but prolongs QTc and requires ECG monitoring with dose changes due to risk of Torsades de Pointes.

Formulation & Access

Brand Names

Sotacor, Solavert

Oral Routes

Tablets (80 mg, 160 mg).

Parenteral

Ampoule for IV use (Rare, highly specialised).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Maintenance of sinus rhythm in AF/AFL, suppression of VT.

Clinical Place

Used when a patient needs both rate and rhythm control, but requires perfect renal function and QT monitoring.

Quick reference

Class & Role

Class III / Non-selective Beta Blocker — Unique agent combining potent non-selective beta-blockade (Class II) with potassium channel blockade (Class III).

Route / Formulation

Tablets (80 mg, 160 mg). (Sotacor, Solavert)

Usual Dose & Max

Start PO 80 mg BD. Titrate slowly under ECG guidance to Max 160 mg BD (320 mg/day).

Key Indication Doses

Best Uses

Sotalol is a unique combined beta-blocker and Class III antiarrhythmic for AF and VT, but prolongs QTc and requires ECG monitoring with dose changes due to risk of Torsades de Pointes.

Avoid / Cautions

Severe asthma, baseline QTc > 450 ms, uncorrected hypokalemia, 2nd/3rd degree heart block, severe renal failure. Pregnancy Category C.

Key Risks

Key Interactions

Any other QT prolonging drugs (e.g., Macrolides, SSRIs, Antipsychotics) risk fatal arrhythmias. Non-DHP CCBs (Verapamil) risk asystole.

Monitoring

Clinical Pearl

Sotalol has a dangerous paradox: its QT-prolonging effect is strongest when the heart rate is SLOW. This makes bradycardic patients exquisitely vulnerable to Torsades de Pointes.

Access

Sotacor, Solavert80 mg tablet

Brand: Sotacor, Solavert
Formulation: Tablets (80 mg, 160 mg)