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sotalol

sotalol

see also beta blockers

Summary:

  • A non-cardioselective beta-adrenergic antagonist devoid of intrinsic sympathomimetic & membrane-stabilizing actions. But unlike other b-blockers, it prolongs action potential duration recorded in cardiac tissue, increases the refractory period & lengthens QT interval.
  • It has less neg. inotrope activity than other b-blockers as it tends to increase contractility by prolongation of action potentials - but may aggravate CCF in some pts.
  • It is an effective antiarrhythmic agent & antifibrillatory agent.
  • It can cause torsade de pointes & thus although relatively safe after AMI, would not be recommended routinely as a substitute for other b-blockers;

Use in SVTs and AF:

  • IV bolus terminated 33% acute atrial flutter & 20% of AF;
  • Efficacy increased with continuous infusion;
  • ? as effective as digoxin + disopyramide Rx for post-op AF/flutter;
  • Oral Rx significantly reduced incidence of AF/flutter post-CABG BUT pro-arrhythmia effects outweigh its benefits.
  • ? Better than quinidine in maintaining sinus rhythm after DC cardioversion of AF BUT pro-arrhythmia effects outweigh its benefits.

Use in unsustained symptomatic complex ventricular activity:

  • As effective as quinidine & better than propranolol or procainamide.
  • this use not recommended at present

Use in sustained ventricular arrhythmias:

  • see VT
  • Better than procainamide in preventing VT/VF recurrence;
  • this use not recommended at present

P/K:

  • readily absorbed orally with near 100% bioavailability → peak [] 2-3hrs;
  • Renally excreted unchanged; T1/2 = 10-15hrs; Not metabolised; Not bound to plasma proteins;

Adverse Effects of sotalol:

  • proarrhythmic 2.5%;
  • heart failure 1%;
  • bradycardia 3%;
  • torsade de pointes 2% pts Rx for malig. vent.arrhythmias- esp. 1st wk with incr. QTc

Drug Interactions of sotalol:

  • as for beta blockers but also any drug that causes prolonged QT interval should be avoided.
sotalol.txt · Last modified: 2009/02/24 21:06 (external edit)