BSN Tracker

sotalol

Brand: Betapace, Sorine

⚠ BBW Prototype: amiodarone
Drug Class: antiarrhythmic (Class III/II)
Drug Family: antiarrhythmic
Subclass: non-selective beta-blocker + potassium channel blocker
Organ Systems: cardiovascular

Mechanism of Action

Non-selective beta-blocker with Class III potassium channel blockade; prolongs QT interval; racemic mixture (L-enantiomer is beta-blocker, D-enantiomer is Class III).

beta-1/beta-2 adrenergic receptorsIKr potassium channel

Indications

  • ventricular arrhythmias (VT/VF)
  • atrial fibrillation (maintenance of sinus rhythm)

Contraindications

  • QT prolongation >450ms
  • hypokalemia
  • CrCl <40 (accumulates)
  • cardiogenic shock
  • 2nd/3rd degree AV block

Adverse Effects

Common

  • bradycardia
  • dizziness
  • fatigue
  • QT prolongation

Serious

  • torsades de pointes (dose-dependent)
  • severe bradycardia
  • proarrhythmia

Pharmacokinetics (ADME)

Absorption ~100% oral bioavailability
Distribution low (hydrophilic)
Metabolism not metabolized — excreted unchanged
Excretion renal
Half-life 12 hours
Onset 2-3 hours
Peak 2.5-4 hours
Duration 24 hours
Protein Binding 0%
Vd 1.2-2.4 L/kg

Drug Interactions

Drug / Agent Mechanism Severity
QT-prolonging drugs additive QT prolongation/TdP major
diuretics (causing hypokalemia) hypokalemia amplifies TdP risk major

Nursing Considerations

  1. QTc monitoring: obtain ECG before each dose increase — hold if QTc >500ms
  2. Requires in-hospital ECG monitoring for first 3 days (REMS program)
  3. Renally cleared — dose interval adjustment in renal impairment
  4. Correct hypokalemia and hypomagnesemia before initiation

Clinical Pearls

  • Hydrophilic: no hepatic metabolism, renally cleared; dose interval extends as CrCl falls
  • Proarrhythmia risk (TdP) highest at low heart rates (reverse use-dependence) and hypokalemia

Safety Profile

Pregnancy avoid
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Antiarrhythmic (Class III/II) Atrial Fibrillation (maintenance Of Sinus Rhythm) Ventricular Arrhythmias (VT/VF)
← Back to Medications