Management of life-threatening arrhythmias, including ventricular tachyarrhythmias and symptomatic non-sustained ventricular tachycardia. Prevention of paroxysmal atrial tachycardia or fibrillation, paroxysmal AV re-entrant tachycardias (both nodal and involving accessory pathways), and paroxysmal supraventricular tachycardia following cardiac surgery. Also used for maintaining sinus rhythm after cardioversion of atrial fibrillation or flutter.

Sotalol is a non-cardioselective beta-adrenergic blocker. It prolongs the sinus cycle length, reduces heart rate, slows AV nodal conduction, and increases AV nodal refractoriness. Additionally, it extends AV monophasic action potentials. It does not possess intrinsic sympathomimetic activity or membrane-stabilizing effects.

Initially 80 mg daily in 1-2 divided doses. After ECG monitoring and measurement of corrected QT interval, arrhythmias, the dose is increased gradually at intervals of 2-3 days to the usual dose of 160-320 mg daily in 2 divided doses; higher doses of 480-640 mg daily for life-threatening ventricular arrhythmias under specialist supervision.

The dosage should be reduced in renal impairment. If creatinine clearance is >60 ml/min, the recommended dose is 160 mg twice daily, while in those with creatinine clearance between 40 and 60 ml/min, the dose is administered once daily. In patients with creatinine clearance less than 40 ml/min, Sotalol is contraindicated.

In combination therapy, clonidine should not be discontinued until several days after stopping Sotalol. Use with caution alongside drugs that prolong the QT interval, such as disopyramide, amiodarone, Class I antiarrhythmic agents, verapamil-type calcium channel blockers, or tricyclic antidepressants. Interactions may also occur with phenothiazines, terfenadine, astemizole, and diltiazem. Concomitant use with reserpine, guanethidine, or alpha-methyldopa requires close monitoring for hypotension, marked bradycardia, or syncope. Hypoglycemia may occur, and dosage adjustments of insulin or antidiabetic agents may be necessary.

Sotalol should not be used in patients with sinus bradycardia, sick sinus syndrome, or second- or third-degree AV block (unless a functioning pacemaker is present); congenital or acquired long QT syndrome; torsades de pointes; uncontrolled congestive heart failure; cardiogenic shock; anesthesia causing myocardial depression; hypotension (except when due to arrhythmia); severe peripheral circulatory disorders; chronic obstructive airway disease or bronchial asthma; renal failure (creatinine clearance <40 mL/min); or known hypersensitivity to Sotalol.

It should also not be used in patients with diabetic ketoacidosis or metabolic acidosis. Therapy with Sotalol may be initiated or resumed only after correction of the metabolic condition.

The most significant adverse effects are those typical of its Class I and Class II activity, particularly prolongation of cardiac action potential duration.

Use during pregnancy should be avoided unless absolutely necessary, as the drug crosses the placenta and may cause fetal bradycardia. Breastfeeding is not recommended for mothers receiving Sotalol, as it may affect the infant.

Sotalol is not suitable for all patients with irregular heart rhythms (such as atrial fibrillation). It should not be used in patients with severe renal impairment or those undergoing dialysis, respiratory diseases causing shortness of breath (including asthma, chronic bronchitis, or emphysema), or symptoms of heart failure (such as exertional dyspnea or swelling of the ankles/legs). It is also not recommended for patients with marked bradycardia who do not have a functioning pacemaker.

Lung disease causing shortness of breath, such as:

• Asthma
• Chronic bronchitis
• Emphysema

Symptoms of heart failure, such as:

• Shortness of breath during exercise or physical activity
• Swelling of the ankles or legs

Very slow heart beat and do not have an implanted artificial pacemaker

Overdose may lead to pronounced bradycardia and hypotension, as well as congestive heart failure, bronchospasm, and hypoglycemia.

Anti-adrenergic agent (Beta-blockers)

Store in a cool, dry place, protected from light.