To minimize the risk of induced arrhythmia, patients initiated or re-initiated on sotalol hydrochloride tablets (AF) should be placed for a minimum of three days (on their maintenance dose) in a facility that can provide cardiac resuscitation, continuous electrocardiographic monitoring and calculations of creatinine clearance. For detailed instructions regarding dose selection, and special cautions for people with renal impairment, see DOSAGE AND ADMINISTRATION. Sotalol is also indicated for the treatment of documented life-threatening ventricular arrhythmias and is available as sotalol hydrochloride tablets. Sotalol hydrochloride tablets however, should not be substituted for sotalol hydrochloride tablets (AF) because of significant differences in labeling (i.e. patient package insert, dosing administration and safety information).
SOTALOL HYDROCHLORIDE TABLETS (AF)
80 mg, 120 mg and 160 mg
Sotalol is an antiarrhythmic drug with Class II (beta-adrenoreceptor blocking) and Class III (cardiac action potential duration prolongation) properties. It is supplied as a light-blue, capsule-shaped tablet for oral administration.
Sotalol is indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia, that in the judgment of the physician are life-threatening. Because of the proarrhythmic effects of sotalol (See WARNINGS), including a 1.5 to 2% rate of torsade de pointes or new VT/VF in patients with either NSVT or supraventricular arrhythmias, its use in patients with less severe arrhythmias, even if the patients are symptomatic, is generally not recommended. Treatment of patients with asymptomatic ventricular premature contractions should be avoided.
Initiation of sotalol treatment or increasing doses, as with other antiarrhythmic agents used to treat life-threatening arrhythmias, should be carried out in the hospital. The response to treatment should then be evaluated by a suitable method (e.g., PES or Holter monitoring) prior to continuing the patient on chronic therapy. Various approaches have been used to determine the response to antiarrhythmic therapy, including sotalol.
In the ESVEM Trial, response by Holter monitoring was tentatively defined as 100% suppression of ventricular tachycardia, 90% suppression of non-sustained VT, 80% suppression of paired VPCs, and 75% suppression of total VPCs in patients who had at least 10 VPCs/hour at baseline; this tentative response was confirmed if VT lasting 5 or more beats was not observed during treadmill exercise testing using a standard Bruce protocol. The PES protocol utilized a maximum of three extrastimuli at three pacing cycle lengths and two right ventricular pacing sites. Response to PES was defined as prevention of induction of the following: 1) monomorphic VT lasting over 15 seconds; 2) non-sustained polymorphic VT containing more than 15 beats of monomorphic VT in patients with a history of monomorphic VT; 3) polymorphic VT or VF greater than 15 beats in patients with VF or a history of aborted sudden death without monomorphic VT; and 4) two episodes of polymorphic VT or VF of greater than 15 beats in a patient presenting with monomorphic VT. Sustained VT or NSVT producing hypotension during the final treadmill test was considered a drug failure.
In a multicenter open-label long-term study of sotalol in patients with life-threatening ventricular arrhythmias which had proved refractory to other antiarrhythmic medications, response by Holter monitoring was defined as in ESVEM. Response by PES was defined as non-inducibility of sustained VT by at least double extrastimuli delivered at a pacing cycle length of 400 msec. Overall survival and arrhythmia recurrence rates in this study were similar to those seen in ESVEM, although there was no comparative group to allow a definitive assessment of outcome.
Antiarrhythmic drugs have not been shown to enhance survival in patients with ventricular arrhythmias.
Sotalol is also indicated for the maintenance of normal sinus rhythm [delay in time to recurrence of atrial fibrillation/atrial flutter (AFIB/AFL)] in patients with symptomatic AFIB/AFL who are currently in sinus rhythm and is marketed under the brand name BETAPACE AF™. Sotalol is not approved for the AFIB/AFL indication and should not be substituted for BETAPACE AF™ because only BETAPACE AF is distributed with a patient package insert that is appropriate for patients with AFIB/AFL.
Published Studies Related to Sotalol
The efficacy of sotalol in preventing postoperative atrial fibrillation: a
supraventricular tachyarrhythmias... CONCLUSION: Sotalol is more effective in the prevention of supraventricular
The Drug And Pace Health cliNical Evaluation (DAPHNE) study: a randomized trial comparing sotalol versus beta-blockers to treat symptomatic atrial fibrillation in patients with brady-tachycardia syndrome implanted with an antitachycardia pacemaker. [2008.08]
BACKGROUND: Atrial tachyarrhythmias (ATAs) are mainly treated by pharmacologic therapy for rate control or rhythm control. The aim of our study was to compare sotalol (S) versus beta-blocking agents (BB) in terms of prevention of ATA, cardioversions (CVs), and cardiovascular hospitalizations (H) in patients paced for bradycardia-tachycardia form of sinus node disease (BT-SND)... CONCLUSIONS: In the complex context of "hybrid therapy" in patients with BT-SND implanted with a modern dual chamber rate adaptive pacemaker device delivering atrial antitachycardia pacing, no differences were found between the use of beta-blocker and the use of S, at the relatively low dose achieved after clinical titration, in terms of prevention of cardiovascular H or need for atrial CV.
The clinical noncompliance of oral sotalol/magnesium for prophylactic treatment of atrial fibrillation after coronary artery bypass grafting. [2007.07]
BACKGROUND: Postoperative atrial fibrillation has been refractory to many attempted pharmacologic prevention methods and, when effective, side effects have been described. The present aim was to study the clinical compliance of a suggested prophylactic treatment, oral sotalol, and magnesium... CONCLUSIONS: The tested treatment protocol showed limited compliance among routine cardiac-surgery patients, and further, introduced a biased selection of patients that skewed the results and may have partly explained the treatment effect.
Azimilide vs. placebo and sotalol for persistent atrial fibrillation: the A-COMET-II (Azimilide-CardiOversion MaintEnance Trial-II) trial. [2006.09]
CONCLUSION: This study demonstrates that the anti-arrhythmic efficacy of azimilide is slightly superior to placebo but significantly inferior to sotalol in patients with persistent AF. The modest anti-arrhythmic efficacy and high rate of torsade de pointes and marked QTc prolongation limit azimilide utilization for the treatment of AF.
Effect of amiodarone and sotalol on ventricular defibrillation threshold: the optimal pharmacological therapy in cardioverter defibrillator patients (OPTIC) trial. [2006.07.11]
CONCLUSIONS: Although amiodarone increased DFT, the effect size with modern ICD systems is very small. Therefore, DFT reassessment after the institution of antiarrhythmic drug therapy with amiodarone or sotalol is not routinely required.
Clinical Trials Related to Sotalol
Genetic Sources of Variability of the Adaptation of the Ventricular Repolarisation [Recruiting]
The main objective is to research for genetic factors involved in the extreme modifications
of the QT interval of the electrocardiogram in answer to a pharmacological stimulation
(sotalol) and physiological stimulation in the apparently normal general population.
The phenotypic characterization, based on the ventricular repolarisation dynamics will be
used aiming at term of the predictive genetic factors of the acquired long QT syndrome
Efficacy and Safety Evaluation of Azimilide or Sotalol vs Placebo for Treatment of Patients With Atrial Fibrillation. [Completed]
Atrial fibrillation (abnormal rhythm in the upper chamber of the heart) is a common
supraventricular arrhythmia (a type of abnormal heart rhythm) for which antiarrhythmic
therapy is often prescribed. The primary goals of therapy are to maintain sinus rhythm
(normal heart rhythm) and to reduce the occurrence of episodes of atrial fibrillation.
The double-blind, placebo-controlled phase of this study is designed to evaluate the efficacy
and safety of oral azimilide compared with placebo and with sotalol, an antiarrhythmic drug,
in maintaining sinus rhythm in patients who require cardioversion (electric shock to correct
heart rhythm) to correct atrial fibrillation. Once this phase of the study is completed, a
second phase with a different study design will be conducted. The second phase is an
open-label, follow-up phase to the first study. The follow-up phase will continue to evaluate
the long-term safety of a daily oral dose of azimilide in patients who complete the
double-blind, placebo-controlled phase of this study.
Comparing the Effects of Amiodarone, Sotalol, and Placebo in Maintaining Sinus Rhythm in Patients With Atrial Fibrillation Converted to Sinus Rhythm [Completed]
Atrial fibrillation is the most frequently occurring cardiac arrhythmia, with 1. 0-1. 5 million
cases annually. It is a risk factor for congestive heart failure, and stroke, 75,000 cases of
the latter occurring annually in patients with atrial fibrillation. The safety of the most
widely used antiarrhythmic agent for this group of patients, quinidine, has been called into
question. This study seeks to determine whether two other agents, amiodarone and sotalol, are
safe and effective treatments for patients with atrial fibrillation.
Pilot Study of Catheter Ablation for Ventricular Tachycardia in Patients With an Implantable Cardioverter Defibrillator [Recruiting]
The purpose of this pilot trial is to determine the feasibility of a large, multi-center
randomized clinical trial aimed to test whether a treatment strategy of percutaneous
catheter ablation of ventricular tachycardia (VT) is superior to state-of-the-art
pharmacologic therapy at reducing all-cause mortality in patients with an implantable
cardioverter defibrillator (ICD) who receive therapy for VT in the absence of any reversible
Kansai Plus Atrial Fibrillation Trial [Recruiting]
This is a 2x2 factorial randomized controlled trial (KPAF Trial), evaluating two different
pharmacological approaches to improve long-term outcome of catheter ablation for atrial
fibrillation (AF). The study is composed of UNmasking Dormant Electrical Reconduction by
Adenosine TriPhosphate (UNDER-ATP) Trial and Efficacy of Antiarrhythmic Drugs Short-Term Use
after Catheter Ablation for Atrial Fibrillation (EAST-AF) Trial. Patients with paroxysmal or
persistent AF will be randomized to ATP guide ablation or control group in a 1: 1 ratio
before the procedure (UNDER-ATP Trial). Excluding those with severe procedural complications
or substantial bradycardia identified first after ablation for persistent AF, patients will
be randomized in a 1: 1 ratio to antiarrhythmic-drug (AAD) or control group after the
procedure (EAST-AF Trial).
Page last updated: 2013-02-10