Class III antiarrhythmic

  • 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
  • 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
  • Katzung BG. Basic & Clinical Pharmacology. 14th ed. United States of America: McGraw-Hill Education; 2018. 239-244 p.
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MBBS CCPU (RCE, Biliary, DVT, E-FAST, AAA) Rob is an Emergency Medicine Advanced Trainee based in Melbourne, Australia. He has special interests in medical education, ECG interpretation, and the use of diagnostic and procedural ultrasound in the undifferentiated and unwell patient.

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