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Sotalol, sold under the brand name Betapace among others, is a medication used to treat and prevent . Evidence does not support a decreased risk of death with long term use. It is taken or given by .

Common side effects include a slow heart rate, , low blood pressure, feeling tired, dizziness, shortness of breath, problems seeing, vomiting, and swelling. Other serious side effects may include , , or . Sotalol is a non-selective β-adrenergic receptor blocker which has both class II and class III antiarrhythmic properties.

Sotalol was first described in 1964 and came into medical use in 1974.

(2025). 9783527607495, John Wiley & Sons. .
It is available as a generic medication.
(2025). 9780857113382, Pharmaceutical Press.
In 2020, it was the 296th most commonly prescribed medication in the United States, with more than 1million prescriptions.


Medical uses
According to the U.S. Food and Drug Administration (FDA), sotalol can be validly used to maintain a normal in people with life-threatening ventricular arrhythmias (e.g., ventricular tachycardia), or very symptomatic atrial fibrillation or . Due to the risk of serious side effects, the FDA states that sotalol should generally be reserved for people whose ventricular arrhythmias are life-threatening, or whose fibrillation/flutter cannot be resolved using the Valsalva maneuver or another simple method. Sotalol has shown some potential efficacy against symptoms of due to its binding to the β2-adrenergic receptor but this remains an .


Contraindications
According to the FDA, sotalol should not be used in people with a waking heart rate lower than 50 beats per minute. It should not be used in people with sick sinus syndrome, long QT syndrome, cardiogenic shock, uncontrolled , or a related bronchospastic condition, or people with serum below 4 meq/L. It should only be used in people with a second and third degree if a functioning is present.

Since sotalol is removed from the body through the kidneys, it should not be used in people with a creatinine clearance rate below 40 mL/min. It is also excreted in , so mothers should not while taking sotalol.

Since sotalol prolongs the , the FDA recommends against using it in conjunction with other medications that prolong the QT interval. Studies have found serious side effects to be more common in individuals also taking , possibly because of pre-existing heart failure in those people. As with other beta blockers, it may with calcium channel blockers, -depleting drugs, or antidiabetic drugs, β2-adrenergic receptor agonists, and .

Some evidence suggests that sotalol should be avoided in the setting of heart failure with a reduced ejection fraction (resulting in the heart squeezing little blood out into the circulation with each pump) due to an increased risk of death.


Adverse effects
Over 10% of oral sotalol users experience fatigue, , , , , , , (slow heart rate), , or . Higher doses of sotalol increase the risk for all of these possible side effects.

In rare cases, the caused by sotalol can lead to the development of life-threatening torsade de pointes (TdP) polymorphic ventricular tachycardia. Across several , 0.6% of oral sotalol patients with supraventricular abnormal heart rhythms (such as atrial fibrillation) developed TdP. For patients who had a history of sustained ventricular tachycardia (abnormal rhythm lasting more than 30 seconds), 4% developed TdP. Risk increases with dosage, female sex, or having a history of an or congestive heart failure. The incidence of TdP for sustained ventricular tachycardia patients was 0% with an 80 mg daily dose, 0.5% at 160 mg, 1.6% at 320 mg, 4.4% at 480 mg, 3.7% at 640 mg, and 5.8% at doses greater than 640 mg. Due to this risk, the U.S. Food and Drug Administration requires affected individuals to be hospitalized for at least three days in a facility that can provide cardiac resuscitation and continuous electrocardiographic monitoring upon starting or restarting sotalol.


Pharmacology

Mechanisms of action

Beta-blocker action
Sotalol is a and non-selectively binds to both β1- and β2-adrenergic receptors preventing activation of the receptors by their stimulatory ligand (). It has no intrinsic sympathomimetic activity.

Without the binding of catecholamines to the β-adrenergic receptor, the complex associated with the receptor cannot activate production of , which is responsible for turning on calcium inflow channels. A decrease in activation of calcium channels will therefore result in a decrease in intracellular calcium. In heart cells, calcium is important in generating electrical signals for heart muscle contraction, as well as generating force for this contraction. In consideration of these important properties of calcium, two conclusions can be drawn. First, with less calcium in the cell, there is a decrease in electrical signals for contraction, thus allowing time for the heart's natural pacemaker to rectify arrhythmic contractions. Secondly, lower calcium means a decrease in strength and rate of the contractions, which can be helpful in treatment of abnormally fast heart rates.


Type III antiarrhythmic action
Sotalol also acts on potassium channels and causes a delay in relaxation of the ventricles. By blocking these potassium channels, sotalol inhibits efflux of K+ ions, which results in an increase in the time before another electrical signal can be generated in ventricular myocytes. This increase in the period before a new signal for contraction is generated, helps to correct arrhythmias by reducing the potential for premature or abnormal contraction of the ventricles but also prolongs the frequency of ventricular contraction to help treat tachycardia.


Pharmacokinetics
Sotalol is classified as a beta blocker with low and hence lower potential for crossing the blood–brain barrier. This in turn may result in fewer effects in the central nervous system as well as a lower risk of side effects.


Chemistry
The experimental of sotalol is 1.1 and its predicted log P ranges from -0.42 to 0.85. It is a or low- beta blocker.


History
Sotalol was first synthesized in 1960 by A. A. Larsen of Mead-Johnson Pharmaceutical.
(2025). 9781843765660, Edward Elgar Publishing. .
It was originally recognized for its effects and its ability to . It was made available in the and in 1974, in 1975, and in 1979. It became widely used in the 1980s. In the 1980s, its antiarrhythmic properties were discovered. The United States approved the drug in 1992.


Society and culture

Brand names
Trade names for Sotalol include Betapace and Betapace AF (Berlex Laboratories), Sotalex and Sotacor (Bristol-Myers Squibb), and Sotylize (Arbor Pharmaceuticals).

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