Sotalol

Mechanism :

Sotalol has both beta-adrenoreceptor blocking and cardiac action potential duration prolongation antiarrhythmic properties. Sotalol hydrochloride is a racemic mixture of d- and l-sotalol. Both isomers have similar Class III antiarrhythmic effects, while the l-isomer is responsible for virtually all of the beta-blocking activity.

Indication :

• Maintenance of sinus rhythm in patients with supraventricular arrhythmias, including paroxysmal supraventricular tachycardia (PSVT), Wolff-Parkinson-White (WPW) syndrome, junctional ectopic tachycardia, paroxysmal atrial tachycardia, and atrioventricular node re-entrant tachycardia.
• Treatment of ventricular arrhythmias, such as sustained ventricular tachycardia.

Contraindications :

Contraindicated in patients with bronchial asthma, sinus bradycardia, second and third-degree AV block, unless a functioning pacemaker is present, congenital or acquired long QT syndromes, cardiogenic shock, uncontrolled congestive heart failure, and previous evidence of hypersensitivity to sotalol.

Dosing :

Adverse Effect :

Bradycardia, dyspnea, chest pain, palpitations, edema, ECG abnormalities, hypotension, proarrhythmia, syncope, heart failure, presyncope, rash, nausea, diarrhea, dyspepsia, abdominal pain, cramps, fatigue, dizziness, asthenia, light-headedness, headache, sleep disturbance, depression, paresthesia, mood changes, anxiety, bronchospasm, visual disturbances, taste abnormalities, hearing disturbances, fever.

Interaction :

Antiarrhythmics: Class Ia antiarrhythmic drugs, such as disopyramide, quinidine and procainamide and other Class III drugs (e.g., amiodarone) are not recommended as concomitant therapy because of their potential to prolong refractoriness.
Digoxin: Proarrhythmic events were more common in patients also receiving digoxin.
Calcium blocking drugs: should be administered with caution 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.
Catecholamine-depleting agents: Concomitant use of catecholamine-depleting drugs, such as reserpine and guanethidine, with a beta-blocker may produce an excessive reduction of resting sympathetic nervous tone.
Insulin and Oral Antidiabetics: Hyperglycemia may occur, and the dosage of insulin or antidiabetic drugs may require adjustment. Symptoms of hypoglycemia may be masked.
Beta-2-Receptor Stimulants: Beta-agonists such as salbutamol, terbutaline and isoprenaline may have to be administered in increased dosages when used concomitantly.
Other: No pharmacokinetic interactions were observed with hydrochlorothiazide or warfarin.

Renal Dose :

Hepatic Dose :