Pharm 101: Sotalol
Class
Class III antiarrhythmic
Beta-blocker
Pharmacodynamics
- Class III antiarrhythmic drug with both class II beta-adrenergic-receptor blocking (class II) and AP prolonging (class III) actions
- Racemic mixture of D- and L-sotalol
- L-isomer contains all of beta-adrenergic-blocking activity
- D- and L-isomers share AP prolonging effects
Pharmacokinetics
- Simple pharmacokinetics, therefore has few direct drug interactions
- Well absorbed orally, bioavailability 100%
- Low lipid solubility
- Not metabolised by liver
- Not plasma protein bound
- Half-life 12 hours
- Renal excretion of predominately unchanged form
Clinical uses
- Ventricular arrhythmias
- Maintenance of sinus rhythm in patients with AF
- Decreases threshold for cardiac defibrillation
Adverse effects
- Prolongs QT:
- Dose-related incidence of TdP (6% at highest recommended daily dose)
- Reduction in LV function in patients with heart failure
- Acute asthma
References
- Katzung BG. Basic & Clinical Pharmacology. 14th ed. United States of America: McGraw-Hill Education; 2018. 239-244 p.
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Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Co-creator of the LITFL ECG Library. Twitter: @rob_buttner