Atrial fibrillation
Second line
Class III antiarrhythmic with β-blocking activity for sinus rhythm maintenance in atrial fibrillation. SEC uses sotalol as an amiodarone alternative in patients without significant structural disease.
Non-selective beta blocker with class III antiarrhythmic activity
ATC code: C07AA07 (Sotalol)
Brand names
Betapace, Sorine
Sotalol combines two mechanisms: non-selective beta-adrenergic blockade and IKr potassium channel blockade (class III antiarrhythmic effect). It prolongs the action potential and the QT interval, which is the basis for its use in ventricular and supraventricular tachyarrhythmias. The main risk is torsades de pointes, particularly during initiation and with hypokalaemia. Sotalol undergoes no hepatic metabolism and is renally cleared; dose reduction applies when creatinine clearance falls below 60 mL/min.
Second line
Class III antiarrhythmic with β-blocking activity for sinus rhythm maintenance in atrial fibrillation. SEC uses sotalol as an amiodarone alternative in patients without significant structural disease.
Second line
Treats symptomatic ventricular arrhythmias and reduces shock frequency in patients with implantable cardioverter-defibrillators.
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FDA Category B. Used to treat fetal tachyarrhythmias through maternal administration. The neonate may develop bradycardia, hypoglycaemia and thyroid dysfunction after third-trimester exposure. SEC monitors maternal and fetal ECG.
Compatible with caution. Hale L3. Transfers into milk at high concentration (RID about 25–30%), the highest among β-blockers. Infant bradycardia and hypoglycaemia are possible; heart rate and glucose monitoring is advised.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Sotalol is evaluated for the following indications with varying evidence strength: Atrial fibrillation (evidence tier B), Ventricular tachycardia (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Sotalol (≥ 1 in 100): Bradycardia, Fatigue, Dyspnoea, Dizziness, Cold extremities. See the Safety section for uncommon and serious reactions.
FDA category B. FDA Category B. Used to treat fetal tachyarrhythmias through maternal administration. The neonate may develop bradycardia, hypoglycaemia and thyroid dysfunction after third-trimester exposure. SEC monitors maternal and fetal ECG.
Compatible with caution. Hale L3. Transfers into milk at high concentration (RID about 25–30%), the highest among β-blockers. Infant bradycardia and hypoglycaemia are possible; heart rate and glucose monitoring is advised.
Sotalol is contraindicated in: Hypersensitivity to sotalol; Sinus bradycardia below 50 bpm; 2nd–3rd degree AV block without pacemaker; QT prolongation (>450 ms men, >470 ms women); Bronchial asthma. Full list in the Safety section.