sotalol hydrochloride

CLINICAL USE

Beta-adrenoceptor blocker:Treatment of life-threatening ventricular arrhythmiasProphylaxis of SVT

DOSE IN NORMAL RENAL FUNCTION

Oral: 80–640 mg per day in single or divided doses (480–640 mg under specialist supervision)IV: 20–120 mg every 6 hours

PHARMACOKINETICS

Molecular weight :308.8

%Protein binding :0

%Excreted unchanged in urine : >90

Volume of distribution (L/kg) :1.6–2.4

half-life – normal/ESRD (hrs) :

10 to 20

/56

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : 50% of normal dose

10 to 20 : 25% of normal dose

<10 : 25% of normal dose and use with caution

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD :Dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: NSAIDs antagonise hypotensive effect

Anti-arrhythmics: increased risk of myocardial depression and bradycardia; increased risk of bradycardia, myocardial depression and AV block with amiodarone; increased risk of ventricular arrhythmias with amiodarone, disopyramide or procainamide – avoid

Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoid

Antidepressants: enhanced hypotensive effect with MAOIs; increased risk of ventricular arrhythmias with tricyclicsAntihistamines: increased risk of ventricular arrhythmias with mizolastine – avoidAntihypertensives: enhanced hypotensive effect; increased risk of withdrawal hypertension with clonidine; increased risk of first dose hypotensive effect with post-synaptic alpha-blockers such as prazosin

Antimalarials: increased risk of bradycardia with mefloquine; avoid with artemether and lumefantrine

Antipsychotics: enhanced hypotensive effect with phenothiazines; increased risk of ventricular arrhythmias with amisulpride, phenothiazines, pimozide or sertindole

Atomoxetine: increased risk of ventricular arrhythmias

Calcium-channel blockers: increased risk of bradycardia and AV block with diltiazem; hypotension and heart failure possible with nifedipine and nisoldipine; asystole, severe hypotension and heart failure with verapamil

Diuretics: enhanced hypotensive effect; increased risk of ventricular arrhythmias due to hypokalaemia 5HT 3 antagonists: increased risk of ventricular arrhythmias with dolasetron – avoid, and tropisetron – use with caution
Ivabradine: increased risk of ventricular arrhythmias

Moxisylyte: possible severe postural hypotension

Sympathomimetics: severe hypertension with adrenaline and noradrenaline and possibly with dobutaminesotalol hydrochloride

ADMINISTRATION

Reconstition

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Route

IV, oral

Rate of Administration

Slow IV bolus with ECG monitoring Over 10 minutes

Comments

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OTHER INFORMATION

Sotalol prolongs the QT interval, which predisposes to the development of torsades de pointesIf used in haemodialysis, give lowest possible dose, after dialysis.

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