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) :1.6–2.4half-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 effectAnti-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 – avoidAntibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoidAntidepressants: 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 prazosinAntimalarials: increased risk of bradycardia with mefloquine; avoid with artemether and lumefantrineAntipsychotics: enhanced hypotensive effect with phenothiazines; increased risk of ventricular arrhythmias with amisulpride, phenothiazines, pimozide or sertindoleAtomoxetine: 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 hypotensionSympathomimetics: severe hypertension with adrenaline and noradrenaline and possibly with dobutaminesotalol hydrochloride ADMINISTRATION
Reconstition
– Route
IV, oral Rate of Administration
Slow IV bolus with ECG monitoring Over 10 minutesComments
– 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.
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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