Sotalol arrhythmia with

Singh, B.N. (1990) in A Symposium ControlUng Cardiac Arrhythmias with Sotalol, a Broad-Spectrum Antiarrhythmic with Beta-Blocking Effects and Class III Activity (Singh, B.N., ed.). Am. J. Cardiol. 65 No. 2 pp. 3A-11 A. 

Sick sinus syndrome Use sotalol only with extreme caution in patients with sick sinus syndrome associated with symptomatic arrhythmias, because it may cause sinus bradycardia, sinus pauses, or sinus arrest. 

Potassium-depleting drugs may cause hypokalaemia, which increases the potential for torsade de pointes arrhythmia with any drug that prolongs the QT interval, including sotalol. 

Concurrent use of the fluoroquinolones with theophylline causes an increase in serum theophylline levels. When used concurrently with cimetidine, the cimetidine may interfere with the elimination of the fluoroquinolones. Use of the fluoroquinolones with an oral anticoagulant may cause an increase in the effects of the oral coagulant. Administration of the fluoroquinolones with antacids, iron salts, or zinc will decrease absorption of the fluoroquinolones. There is a risk of seizures if fluoroquinolones are given with the NSAIDs. There is a risk of severe cardiac arrhythmias when the fluoroquinolones gatifloxacin and moxifloxacin are administered with drains that increase the QT interval (eg, quini-dine, procainamide, amiodarone, and sotalol). 

Sotalol (13) is a racemic mixture, and its two enantiomers have been studied extensively [47-51]. As expected from studies with other ff-blocking agents, the Class II activity resides predominantly in only one enantiomer [(-)-sotalol] while the Class III activity can be found equally in both enantiomers. Therefore, the (-I-)-enantiomer, which is essentially devoid of P-blocking activity, has been studied as one of the few early examples of a selective Class III agent. Both sotalol [52-55] and its enantiomer, (-l-)-sota-lol [56-58], have been shown to be clinically effective in the prevention of ventricular arrhythmias. The efficacy rate for suppression of inducible ventricular tachycardia during programmed electrical stimulation for both... 

Exercise extreme caution in the use of sotalol in patients with renal failure undergoing hemodialysis. The half-life of sotalol is prolonged (up to 69 hours) in anuric patients. However, sotalol can be partly removed by dialysis with subsequent partial rebound in concentrations when dialysis is completed. Safety (heart rate, QT interval) and efficacy (arrhythmia control) must be closely monitored. 

Proarrhythmia Like other antiarrhythmic agents, sotalol can provoke new or worsened ventricular arrhythmias in some patients, including sustained ventricular tachycardia or ventricular fibrillation, with potentially fatal consequences. Because of its effect on cardiac repolarization, is the most common form of proarrhythmia associated with sotalol, occurring in approximately 4% of high-risk patients. 

Concomitant use of calcium channel blockers (atenolol) Bradycardia and heart block can occur and the left ventricular end diastolic pressure can rise when beta-blockers are administered with verapamil or diltiazem. Patients with preexisting conduction abnormalities or left ventricular dysfunction are particularly susceptible. Recent acute Ml (sotalol) Sotalol can be used safely and effectively in the long-term treatment of life-threatening ventricular arrhythmias following an Ml. However, experience in the use of sotalol to treat cardiac arrhythmias in the early phase of recovery from acute Ml is limited and at least at high initial doses is not reassuring. 

Tachy-arrhythmias may be treated with a /3i-selective blocker. Sotalol may be used in the treatment of postoperative atrial fibrillation, which is observed frequently following cardiac surgery. 

Sotalol possesses a broad spectrum of antiarrhythmic effects in ventricular and supraventricular arrhythmias. It has value in the management of patients with paroxys-... 

Sotalol is approved for the treatment of life-threatening ventricular arrhythmias and the maintenance of sinus rhythm in patients with atrial fibrillation. It is also approved for treatment of supraventricular and ventricular arrhythmias in the pediatric age group. Sotalol decreases the threshold for cardiac defibrillation. 

Comparison of sotalol with six other drugs with respect to deaths due to cardiac arrhythmias. 

PROPAFENONE I. ANTIARRHYTHMICS - disopyra-mide, procainamide 2. ANTIBIOTICS - macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/ dalfopristin 3. ANTICANCER AND IMMUNOMODULATING DRUGS -arsenic trioxide 4. ANTIDEPRESSANTS - TCAs, venlafaxine 5. ANTIEMETICS-dolasetron 6. ANTIFUNGALS-fluconazole, posaconazole, voriconazole 7. ANTIHISTAMINES - terfenadine, hydroxyzine, mizolastine 8. ANTI-M ALARIALS - artemether with lumefantrine, chloroquine, hydroxychloroquine, mefloquine, quinine 9. ANTIPROTOZOALS - pentamidine isetionate 10. ANTIPSYCHOTICS-atypicals, phenothiazines, pimozide II. BETA-BLOCKERS - sotalol 12. BRONCHODILATORS -parenteral bronchodilators 13. CNS STIMULANTS - atomoxetine Risk of ventricular arrhythmias, particularly torsades de pointes Additive effect these drugs prolong the Q-T interval. Also, amitriptyline, clomipramine and desipramine levels may be t by propafenone. Amitriptyline and clomipramine may t propafenone levels. Propafenone and these TCAs inhibit CYP2D6-mediated metabolism of each other Avoid co-administration... 

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