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 (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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