Sotalol dosing

Ventricular fibrillation should be terminated by electrical defibrillation. Alternatively, lidocaine can be injected intravenously. In cases with lower frequency, ventricular tachyarrhythmia class I diugs such as aj marine, flecainide or propafenone are more effective as a result of the use-dependence of lidocaine. For prophylaxis treatment, amiodarone or sotalol may be helpful or the implantation of a cardioverter-defibrillator system. Acute amiodarone (i.v. in higher doses) can also terminate ventricular tachyarrhythmias. This action, however, seems to be mediated by its INa-blocking side effects and not (or less) by its class III like effects. 

Sotalol Sotalol has both Class II (beta blocking) and III properties Class III effects are seen at doses greater than 160 mg. 

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. 

Uses Rapid conversion of AF/artmal fluto Action Class III antiarrhythmic Dose Adults >60 kg. 0.01 mg/kg (max 1 mg) IV inf over 10 min may repeat x 1 <60 kg Use 0.01 mg/kg (ECC 2005 D/C cardioversion preferred) Caution [C, -] Contra w/ class I/III antiarrhythmics (Table VI-7) QTc >440 ms Disp Inj SE Arrhythmias, HA Interactions t Refractory effects W7 amiodarone, disopyra-mide, procainamide, quinidine, sotalol t QT int val W7 antihistamines, antidepressants, erythromycin, phenothiazines, TCAs EMS Use antihistamines w/ caution, may T QT interval OD May cause increased repolarization leading to arrhythmias, bradycardia, hypotension leading to cardiac arrest symptomatic and supportive... 

Sotalol (Betapace) [Antiarrhythmic, Antihypertensive/Beta Blocker] WARNING Monitor pts for 1st 3 d of Rx to 4- risks of arrhythmia Uses Ventricular arrhythmias, AF Action p-Adrenergic blocking agent Dose Adults. 80 mg PO bid may be T to 240-320 mg/d Peds. Neonates 9 mg/m tid... 

The cornerstone of therapy for ventricular fibrillation is electrical deflbrillation. In the acute setting, defibrination is first-line therapy. Intravenous bretylium can occasionally contribute to conversion, but this is infrequent. In the management of out-of-hospital cardiac arrest, high-dose epinephrine (5 mg intravenously) improves the rate of successful resuscitation in patients with asystole, but not in those with ventricular fibrillation, when compared with the standard dose of 1 mg. Vasopressin (40 U intravenously) may more effective than 1 mg intravenous epinephrine in out-of-hospital patients with ventricular fibrillation that is resistant to electrical defibrillation. The OPTIC smdy (see Connolly et al., 2006) showed that amiodarone plus jS-blocker is superior than sotalol or jS-blocker alone for reducing ICD shocks in patients with reduced left ventricular function and history of sustained VT, VF, or cardiac arrest. 

In addition to class III actions, sotalol (Betapace) possesses 3-adrenoceptor blocking properties. The 3-blocking effects are most evident at low doses, with action potential prolongation predominating at higher doses. The D-isomer of sotalol, which is devoid of 3-blocking action, may increase mortality in post-infarcted patients. 

Administration of sotalol is associated with dose- and concentration-dependent slowing of the heart rate and prolongation of the PR interval. The QRS duration is not affected with plasma concentrations within the therapeutic range. The corrected QT interval is prolonged as a result of the increase in the ERP of ventricular myocardium. 

Sotalol is well absorbed orally with bioavailability of approximately 100%. It is not metabolized in the liver and is not bound to plasma proteins. Excretion is predominantly by the kidneys in the unchanged form with a half-life of approximately 12 hours. Because of its relatively simple pharmacokinetics, solatol exhibits few direct drug interactions. Its most significant cardiac adverse effect is an extension of its pharmacologic action a dose-related incidence of torsade de pointes that approaches 6% at the highest recommended daily dose. Patients with overt heart failure may experience further depression of left ventricular function during treatment with sotalol. 

Amiodarone has a higher incidence of side effects than sotalol. Seventy-five percent of patients report side effects over 5 years with 15-35 percent requiring discontinuance of the drug. Severe adverse effects, including pulmonary fibrosis, can occur with usual doses of amiodarone and may be lethal or irreversible or persist for months after treatment is stopped. 

BETA-BLOCKERS ANTIDIARRHOEALS -KAOLIN Possibly 1 levels of atenolol, propanolol and sotalol 1 absorption Separate doses by at least 2 hours... 

Kochiadakis GE, Igoumenidis NE, Marketou ME, Kaleboubas MD, Simantirakis EN, Vardas PE. Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation a comparative, placebo controlled study. Heart 2000 84(3) 251-7. 

All beta-blockers cause an increase in atrioventricular conduction time this is most pronounced with drugs that have potent membrane-depressant properties and no partial agonist activity. Sotalol differs from other beta-blockers in that it increases the duration of the action potential in the cardiac Purkinje fibers and ventricular muscle at therapeutic doses. This is a class III antidysr-hythmic effect, and because of this, sotalol has been used to treat ventricular (54-56) and supraventricular dysrhythmias (57). The main serious adverse effect of sotalol is that it is prodysrhythmic in certain circumstances, and can cause torsade de pointes (58,59). 

The list of beta-adrenoceptor antagonists that have been detected in breast milk includes atenolol (322), acebutolol and its active A-acetyl metabolite (323), metoprolol (324), nadolol (325), oxprenolol and timolol (326), propranolol (327), and sotalol (328). Most authors have concluded that the estimated daily infant dose derived from breastfeeding is likely to be too low to produce untoward effects in the suckling infant, and indeed such effects were not noted in the above cases. However, in the case of... 

In a randomized, double-blind, placebo-controlled comparison of propafenone (mean dose 13 mg/kg/day n = 102) and sotalol (mean dose 3 mg/kg/day n = 106) in maintaining sinus rhythm after conversion of recurrent symptomatic atrial fibrillation in 300 patients, efficacy was comparable (13). Tolerable adverse effects in those who took propafenone were gastrointestinal discomfort (n — 15), neurological disturbances (n = 9), a metallic taste (n = 4), and generalized weakness (n = 1) nine patients withdrew owing to adverse effects, four with gastrointestinal disorders, three with dizziness, and two with headache there were no prodysrhythmias. 

Sotalol 80 bid 160 mg b.i.d. 70% 100% 50% 25%-50% Extreme caution should be exercised in the use of sotalol in patients with renal failure undergoing hemodialysis to minimize the risk of induced arrhythmia, patients initiated or reinitiated on BETA-PACE should be placed for a minimum of 3 days (on their maintenance dose) in a facility that can provide cardiac resuscitation and continuous electrocardio-araohic monitorina 80 mg NC Dose for GFR 10-50 ml/min... 

MEA hESC-derived Prolongation of cFPD Sotalol 10-400 pM Dose-dependent... 

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