Sotalol interaction

Drug/Food interactions Food enhances the bioavailability of metoprolol and propranolol this effect is not noted with nadolol, bisoprolol, or pindolol. The rate of carteolol and penbutolol absorption is slowed by the presence of food however, extent of absorption is not appreciably affected. Sotalol absorption is reduced approximately 20% by a standard meal. 

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 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. 

Sotalol is a beta-blocker that also has class III antiarrhythmic effects, It causes prolongation of the Q-T interval and is recommended solely as an antiarrhythmic. It is included in this section because it is subject to interactions from its betablocking properties as well as its Q-T prolongation... 

The bradycardia produced by digoxin can be enhanced by beta-adrenoceptor antagonists. Neostigmine enhances vagal activity and can aggravate bradycardia (410). An apparent interaction between sotalol and thiazide-induced hypokalemia, resulting in torsade de pointes (411), has prompted the withdrawal of the combination formulation Sotazide. 

In a Prescription-Event Monitoring study in 3085 patients, mean age 65 years, there were 11 possible drug interactions. Nine involved beta-blockers, with eight reports of bradycardia and one of syncope. One patient developed palpitation and dyspnea while also taking digoxin and sotalol. 

Clinically important, potentially hazardous interactions with amiodarone, procainamide, quinidine, sotalol... 

Clinically important, potentially hazardous interactions with amiodarone, bepridil, cisapride, disopyramide, droperidol, erythromycin, flecainide, levodopa, pentamidine, procainamide, quinidine, sotalol, sparfloxacin, terfenadine, thioridazine... 

Clinically important, potentially hazardous interactions with abacavir, amiodarone, bretylium, chlorpromazine, ciprofloxacin, disopyramide, enoxacin, fluphenazine, gatifloxacin, lomefloxacin, mesoridazine, moxifloxacin, norfloxacin, ofloxacin, phenothiazines, procainamide, prochlorperazine, promethazine, quinidine, quinolones, sotalol, sparfloxacin, thioridazine, trifluoperazine... 

Clinically important, potentially hazardous interactions with amiodarone, azithromycin, bepredil, bosentan, bretylium, cisapride, clarithromycin, disopyramide, erythromycin, erythromycin fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, miconazole, nefazodone, nilotinib, paroxetine, pimozide, probucol, procainamide, quinidine, quinine, ritonavir, saquinavir, sertraline, sotalol, SSRIs, terfenadine, troleandomycin, voriconazole, zileuton, ziprasidone... 

Clinically important, potentially hazardous interactions with aminophylline, amiodarone, antacids, antineoplastics, arsenic, bepridil, bismuth, bismuth subsalicylate, bretylium, calcium salts, cocoa, didanosine, disopyramide, duloxetine, erythromycin, iron, magnesium salts, meptazinol, methylxanthines, NSAIDs, phenothiazines, procainamide, quinidine, rasagiline, sotalol, sucralfate, tizanidine, tricyclic antidepressants, zinc... 

Clinically important, potentially hazardous interactions with cyclosporine, diltiazem, dofetilide, erythromycin, grapefruit, ketoconazole, quinidine, ritonavir, simvastatin, sotalol, thioridazine, verapamil, ziprasidone... 

Clinically important, potentially hazardous interactions with amiodarone, amisulpride, amitriptyline, amoxapine, arsenic, bepridil, bretylium, calcium, chlorpromazine, clomipramine, desipramine, disopyramide, doxepin, erythromycin, fluphenazine, imipramine, iron salts, magnesium, mesoridazine, nortriptyline, pentamidine, perphenazine, phenothiazines, pimozide, procainamide, prochlorperazine, promazine, promethazine, protriptyline, quinidine, sotalol, sucralfate, thioridazine, tricyclic antidepressants, trifluoperazine, trimipramine, zinc salts... 

Clinically important, potentially hazardous interactions with alcohol, amiodarone, anticholinergics, antihistamines, barbituates, cisapride, dofetilide, doxazosin, erythromycin, guanethidine, hydralazine, levodopa, lithium, methyldopa, metoclopramide, moxifloxacin, piperazine, quinidine, sibutramine, sotalol, thiazide diuretics, thioridazine... 

Hypotension, bradycardia, ventricular fibrillation and asystole have been seen in a few patients given amiodarone with propranolol, metoprolol or sotalol (for sotalol, see also Drugs that prolong the QT interval + Other drugs that prolong the QT interval , p.2S7). However, analysis of clinical trials su ests that the combination can be beneficial. Amiodarone may inhibit the metabolism of beta blockers metabolised by CYP2D6, such as metoprolol, which might be a factor in the interaction. 

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