Drug Details

Sotalol

( Betapace Af )

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Dec 17, 2024

Sotalol Drug Details

Generic Name:

Sotalol hydrochloride

Common Brands:

Betapace, Betapace AF, Sorine, Sotylize

Availability:

Prescription only

Therapeutic Class:

Antiarrhythmics

Forms:

Tablet, oral solution, injection solution

Administration:

Oral (by mouth), intravenous (by injection into a vein)

Therapeutic Uses:

To treat life-threatening ventricular arrhythmias
To prevent recurrence of atrial fibrillation and atrial flutter in people who are currently in sinus rhythm

Controlled Status:

Not a controlled substance

Sotalol (Betapace Af) Drug Class

Sotalol (soe-tah-lole) is an antiarrhythmic medication.

Sotalol (Betapace Af) Age Range

Sotalol is approved for use in adults and children.

Sotalol Uses

Sotalol (Betapace Af) Uses

Sotalol oral is used to treat life-threatening ventricular arrhythmias (irregular heartbeats). It is also used for maintenance of normal sinus rhythm and prevention of recurrent Afib Afl (atrial fibrillation and atrial flutter) in people who have had these heart rhythm abnormalities in the past. However, it is not used to treat atrial fibrillation.

There may be other uses for sotalol—your doctor or health system pharmacists can give you further drug information.

Sotalol (Betapace Af) Mechanism of Action

Sotalol decreases abnormal electrical signals in the heart and stabilizes irregular heart rhythms in patients with ventricular arrhythmia. It also helps to maintain normal sinus rhythm in patients with a history of atrial flutter and fibrillation.

Sotalol (Betapace Af) Doses

Sotalol oral is available in tablet form in strengths of 80 mg, 120 mg, and 160 mg. It is also available as a liquid solution of 5 mg/mL (brand name Sotylize). There is also an injection solution of 15 mg/mL available for use in healthcare settings.

Sotalol doses administered are as follows:

For ventricular arrhythmia in adults: An initial starting dose of 80 mg twice daily, which may be increased by 80 mg per day every 3 days as long as the QT interval (QTc) is less than 500 msec. Clinical response is typically achieved at total daily doses ranging between 160 mg and 320 mg, given in 2-3 divided doses. Doses up to 480 mg and 640 mg daily (maximum recommended human dose) have been used in patients with life-threatening refractory arrhythmias.

For prevention of recurrent atrial flutter or fibrillation in adults: An initial starting dose of 80 mg twice daily, which may be increased by 80 mg per day every 3 days as long as the QTc is less than 500 msec. Clinical response is typically achieved at a dose of 120 mg twice daily.

Sotalol dosing in children: The recommended initial dose is 1.2 mg/kg three times a day (total daily dose of 3.6 mg/kg), which is roughly equal to a total daily dose of 160 mg in adults. The dose in children may be increased to a maximum of 2.4 mg/kg three times a day, which is roughly equal to a total daily dose of 360 mg in adults.

Sotalol Directions

How To Use Sotalol (Betapace Af)

Sotalol comes as a tablet and oral solution to take by mouth 1 to 3 times a day as prescribed. Try to take sotalol at around the same times every day. You can take this medicine with or without food, but you should do so consistently.

You will likely need to stay in the hospital when you are first starting sotalol for at least 3 days or until steady state plasma concentrations of the drug are reached (steady drug levels in blood). This will need to be done in a medical facility that has cardiac resuscitation and continuous heart monitoring facilities as well as healthcare personnel who are trained in managing serious cardiac arrhythmias.

Your doctor will perform a baseline ECG to measure your QT interval as well as blood tests to measure serum potassium and magnesium levels before starting sotalol treatment. They will also measure serum creatinine to ensure normal renal function (kidney function) and calculate the estimated creatinine clearance to calculate a safe dosing interval. People with reduced creatinine clearance (40 to 60 mL/min) may require less frequent dosing. Your QTc (QT interval) will need to be monitored every 2 to 4 hours after dose increments.

Read the prescription label carefully and take sotalol exactly as advised. Do not change the dose or dosage frequency of the antiarrhythmic drug without your doctor’s approval.

Your doctor will start you on a low dose of sotalol and increase the dose gradually. Follow your doctor’s dosing instructions and take the medicine as directed by your doctor.

Sotalol can help to control your heart rhythm abnormality but will not cure the underlying condition. Continue treatment with sotalol even if you feel well. Do not stop taking sotalol suddenly - this can put you at an increased risk of serious heart problems, including ischemic heart disease, i.e., chest pain (angina) and heart attack. Your doctor will tell you how to reduce the dose slowly over 1-2 weeks while avoiding strenuous physical activity.

Missed dose: If you miss a dose of sotalol, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose according to your regular dosing schedule. Do not take a double dose or extra medicine to make up for a missed dose.

Storage: Store sotalol at room temperature (between 15-30° C or 59-86° F) away from moisture, heat, and direct light in a tightly closed container. Do not store medications in the bathroom, where they can be exposed to moisture and heat. Keep all medications safely out of reach of children and pets.

Unused medicine: Unused or expired sotalol should be disposed of in a way that children, other people, and pets cannot get to them. Do not throw sotalol in the trash or flush it down the toilet. The best way to dispose of expired or unneeded sotalol is through your local waste disposal company or a drug take-back program. Learn more about proper medication disposal.

NOTE: This medication guide is a summary and may not contain all possible drug information on sotalol. The information contained here may not be up-to-date. This sheet is for information purposes only. If you have questions about sotalol, talk to your healthcare professionals for medical advice.

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Sotalol Side Effects

Sotalol (Betapace Af) Side Effects

Possible side effects of sotalol are listed below. Tell your doctor if these side effects are severe or continue after a few days.

Lightheadedness or dizziness
Tiredness
Weakness
Headache
Nausea
Vomiting
Diarrhea

Sotalol can also cause more serious side effects. Call your doctor immediately or seek emergency medical attention if you develop the following symptoms:

An unusual or allergic reaction (skin rash, hives, itching)
Wheezing
Shortness of breath or difficulty breathing
Swelling of the lower legs, ankles, or feet
Unexplained weight gain
Fast, slow, or irregular heartbeat
Chest pain
Fainting
Severe diarrhea, vomiting, excessive thirst, excessive sweating, or decreased appetite

The above list may not include all the potential adverse effects of sotalol. Contact your healthcare professional if your side effects are unusual or severe or do not improve over time. You can also report unusual side effects to the Food and Drug Administration at 1-800-FDA-1088.

Sotalol (Betapace Af) Overdose: In case of an overdose of sotalol, call your doctor immediately. You can also call the local poison control center or national poison control center at 1-800-222-1222. Call 911 if a person cannot be awakened, has trouble breathing, has collapsed, or has had a seizure. Symptoms of a sotalol overdose may include a fast, slow, or irregular heartbeat, dizziness, fatigue, weakness, fainting, wheezing, cough, difficulty breathing, and swelling in the legs and feet.

Source: FDA

Sotalol Warnings

Sotalol (Betapace Af) Risks, Warnings, and Complications

Sotalol can cause or worsen health problems in some people. Talk with your doctor about other treatment options for an irregular heartbeat if you are at a high risk of complications from this medication. Some of the risks of sotalol use include:

QT PROLONGATION AND PROARRHYTHMIA: Sotalol can be used to treat an abnormal heartbeat but can also cause serious life-threatening ventricular arrhythmias such as sustained ventricular tachycardia and ventricular fibrillation, Torsade de Pointes, and tachycardia associated with QT interval prolongation. These are called proarrhythmias, which are new arrhythmias or aggravation of pre-existing arrhythmias at doses of drugs that are not typically toxic.
Risk factors include decreased creatinine clearance, female gender, higher doses of sotalol, slow heartbeat, and a history of sustained VT/VF or heart failure. Your doctor will adjust your sotalol dose based on your kidney function. They will also monitor ECG for increases in the QT interval. Sotalol is not prescribed to people with a QT interval of more than 450 msec.
In addition, your doctor will check for and correct hypokalemia (low potassium) and hypomagnesemia (low magnesium) before starting sotalol because these electrolyte imbalances can worsen QT prolongation and increase the risk of Torsade de Pointes.
Tell your doctor if you develop severe or prolonged diarrhea while on sotalol, which can affect electrolyte levels. Also, tell your healthcare provider if you take concomitant diuretic drugs (water pills). Give your doctor a complete list of your medications. The use of sotalol is not recommended with other drugs that can also cause QT prolongation.
BRADYCARDIA, HEART BLOCK, SICK SINUS SYNDROME: Sinus bradycardia (slow heartbeat with a rate of less than 50 beats per minute) can occur in patients receiving sotalol. Bradycardia is a risk factor for serious complications such as Torsade de Pointes, which is a type of ventricular tachycardia. Other potential symptoms of beta-blockade, such as sinus pause, sinus arrest, and sinus node dysfunction occur in some patients, as do second or third-degree AV block. Your doctor will not prescribe sotalol to you if you have a history of sick sinus syndrome and are at a high risk of heart rhythm complications.
HYPOTENSION: Sotalol, like other beta blockers, can lead to a decrease in both systolic and diastolic blood pressure, resulting in hypotension (low blood pressure). Your healthcare provider will monitor your blood pressure regularly. Tell your doctor if you have low blood pressure on checking at home or signs and symptoms such as lightheadedness, dizziness, or fainting.
HEART FAILURE: People receiving sotalol can develop new or worsening heart failure because of its beta-blocking effects. Your health care provider will monitor you for signs and symptoms of heart failure such as swelling of the legs and feet and sudden weight gain. You may need to discontinue sotalol if this complication develops.
CARDIAC ISCHEMIA WITH SUDDEN DISCONTINUATION: Suddenly stopping sotalol can lead to cardiac ischemia (reduced blood supply to the heart), causing angina pectoris (chest pain) or myocardial infarction (heart attack). If you are stopping sotalol therapy, your doctor will tell you how to gradually reduce the dose over 1-2 weeks. You will need to avoid strenuous physical activity during this time. If you develop new or worsening chest pain, you may need to take an alternative beta blocker.
BRONCHOSPASM: People with bronchospastic diseases such as chronic bronchitis and emphysema should not take beta blockers. If such patients with lung conditions need to be on sotalol, their doctor will prescribe the smallest effective dose to lower the risk of bronchospasm (tightening of the airways).
EFFECTS ON BLOOD GLUCOSE: Beta-blockers, including sotalol, can mask the early warning signs of hypoglycemia (low blood sugar), such as fast heart rate. This can increase the risk of severe or prolonged hypoglycemia, especially in people with diabetes mellitus and those who are not eating regularly, vomiting, or have upcoming surgery. You should know how to recognize hypoglycemia and what to do if it occurs. You may need to seek emergency treatment for low blood sugar. In addition, elevated blood glucose levels and increased insulin requirements may occur in people with diabetes.
THYROID ABNORMALITIES: Sudden discontinuation of beta-blockade in people with thyroid disease can lead to worsening symptoms of hyperthyroidism (overactive thyroid gland), including thyroid storm. The use of beta-blockers can mask some of the clinical signs of hyperthyroidism, such as tachycardia (fast heart rate).
SEVERE ALLERGIC REACTIONS: People with a history of anaphylactic reaction (severe allergic reaction) to drugs, foods, and other allergens may have a more severe reaction while they are on beta-blockers. Such individuals may not respond to the usual doses of epinephrine to treat allergic reactions.
MAJOR SURGERY: Long-term treatment with beta-blockers does not usually need to be stopped before major surgery. However, beta blockers can affect the ability of the heart to respond to certain stimuli and increase the risks associated with general anesthesia. Tell your doctors you are taking sotalol for an abnormal heartbeat before any surgical procedure.

Precautions Before Starting Sotalol (Betapace Af)

Tell your doctor if you have ever had allergic reactions to sotalol, any of the active or inactive ingredients in sotalol formulations, other antiarrhythmic drugs, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of all your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal products. This can help prevent possible interactions between sotalol and your other medicines.

Give your doctor a complete medical history. Sotalol may not be safe for people with certain medical conditions, such as lung disease, heart disease (coronary artery disease, congestive heart failure), diabetes, low potassium, low magnesium, hyperthyroidism (overactive thyroid), or serious allergic reactions in the past.

Tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy, or are breastfeeding.

Precautions During Use of Sotalol (Betapace Af)

Keep all your medical and laboratory appointments during treatment with sotalol. Your doctor may want to adjust your dose, order certain laboratory tests, and monitor your heart rhythm.

Take aluminum- and magnesium-containing medicines such as antacids (Mylanta, Maalox) at least two hours away from your sotalol dose.

Sotalol can cause drowsiness and dizziness. Do not drive or operate heavy machinery until you know how this medicine affects you.

Treatment with sotalol for an abnormal heart rhythm can mask symptoms such as fast heartbeat which are signs of health complications such as hypoglycemia (low blood sugar) or hyperthyroidism (overactive thyroid). You should know how to recognize hypoglycemia (hunger, shakiness, sweating, confusion, dizziness) and seek medical care if you develop low blood glucose. Tell your doctor if you are not eating or drinking normally or have vomiting while on sotalol.

If you have a history of serious allergic reactions and carry epinephrine, you should know that you may not respond to the usual doses of epinephrine while on treatment with sotalol.

Tell all your healthcare professionals you are taking sotalol, especially before surgical procedures, including dental treatment.

Tell your doctor if you become pregnant while on this medicine.

Sotalol (Betapace Af) Drug Interactions

Taking sotalol with certain other drugs can affect how it works. Possible drug interactions between sotalol and your other medications can increase the risk of potentially serious adverse reactions. Your doctor may change the dose of your medications, switch you to a different medication, and/or monitor you carefully for serious side effects if there are known interactions between sotalol and your other medicines. Sotalol can have interactions with the following medications:

Calcium channel blockers such as bepridil
Anti-ulcer drugs such as cisapride
Other antiarrhythmics such as dronedarone and vernakalant
Medications prescribed for multiple sclerosis, such as fingolimod
Certain antibiotics such as grepafloxacin and sparfloxacin
Cortisol synthesis inhibitors such as levoketoconazole
Medications used to manage opiate dependence, such as levomethadyl
Antipsychotic medications such as mesoridazine, thioridazine, pimozide, and ziprasidone
Antimalarials such as piperaquine
HIV medications such as saquinavir
Antihistamines such as terfenadine

The above list may not include all the possible interactions of sotalol. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal remedies. Also, tell your healthcare provider if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and over-the-counter medicines.

Sotalol Pros & Cons

Sotalol (Betapace Af) Pros and Cons

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Sotalol works well to treat certain types of life-threatening ventricular arrhythmias. It can also prevent recurrence of Afib Afl (atrial fibrillation and atrial flutter) and help in maintenance of normal sinus rhythm in people with a history of these types of abnormal heartbeat.
There is a lower-cost generic available.
People who have trouble swallowing pills can take the sotalol oral solution.

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You need to stay in the hospital for at least 3 days when first starting sotalol treatment.
It can cause certain types of life-threatening arrhythmias and requires close monitoring.
Sotalol may not be safe for people with lung disease, heart failure, or kidney problems.

Sotalol Pharmacist Tips

Sotalol (Betapace Af) Tips from Pharmacists

You can take oral sotalol without regard to meals, but you should consistently take it with food or without food.
Keep all your medical and laboratory appointments while on sotalol therapy. Your health care provider will order blood tests to measure electrolyte levels and kidney function as well as monitor heart rate, blood pressure, and ECG.
Do not start any new medications while taking sotalol without checking with your doctor first. Interactions between sotalol and other medications can cause serious adverse effects.
Tell your doctor if you feel lightheaded, dizzy, or faint. You may have hypotension (low blood pressure) and your doctor may adjust your sotalol dose.
Talk to your doctor about adjusting the dose of your insulin and other diabetes medications if you have diabetes mellitus. Also, discuss how often you should measure blood glucose levels. Sotalol can mask some of the symptoms of hypoglycemia (low blood sugar) such as a fast heart rate.
Do not stop taking sotalol suddenly. This can put you at risk of chest pain and heart attack. Your doctor will tell you how to reduce the dose gradually.

Sotalol Rx Savings Tips

Sotalol (Betapace Af) Rx Savings Tips

Sotalol is a generic medication and is available at significantly lower prices than the brand names. Brand names Betapace AF, Betapace, Sorine, and Sotylize and generic sotalol contain the same medicine and are equally effective and safe. Like with most medications, the generic drug offers better value. A BuzzRx sotalol coupon can result in big savings on the brand names and generic form of the drug. With a BuzzRx discount card, savings card, or discount coupons, the medication could cost you a fraction of retail prices. Sotalol may be under $13.00 for 60 tablets of the 80 mg dose at Walmart, Walgreens, Rite Aid, CVS Pharmacy, and other participating pharmacies with a BuzzRx discount card or free coupon. For the biggest discounts on sotalol, give the checkout clerk your BuzzRx sotalol discount coupon when you drop off your prescriptions at the pharmacy counter.

Lowest Price for Sotalol (Betapace Af)

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Sotalol Common Questions

Common Questions about Sotalol (Betapace Af)

Is sotalol a beta blocker?

Yes, sotalol is a beta-blocker. It is used to treat and prevent certain types of arrhythmias (heart rhythm abnormalities). Sotalol is a non-selective beta blocker and affects both the heart and lungs.

Is sotalol the same as metoprolol?

No, sotalol is not the same as metoprolol. Both sotalol and metoprolol are beta blockers, but they are used to treat different conditions.

Does sotalol lower blood pressure?

Yes, sotalol can lower blood pressure due to its beta blocking effects. Tell your doctor if you notice low blood pressure readings at home. Also, tell your doctor if you develop lightheadedness, dizziness, or fainting, which can be signs of hypotension (low blood pressure).

How quickly does sotalol start working?

Sotalol starts working within a few hours of taking a dose, but it can take 2-3 days for you to get the full benefits. You will have to stay in the hospital for at least 3 days when first starting sotalol for careful monitoring.

Can you take sotalol long-term?

Sotalol is generally safe to take long-term. Do not stop taking sotalol suddenly after taking it for a long time. Your doctor will tell you how to reduce the dose slowly.

What is the price of sotalol without insurance?

Without insurance, sotalol can be as high as $140.98, but with a free BuzzRx prescription discount coupon, you could pay as low as $12.74 for the most common version of this medication. Use the BuzzRx drug price look-up tool to find the lowest discounted price, and be sure to enter the correct dosage, form, and quantity for the most accurate pricing. While generics tend to have the best savings, you can also use your BuzzRx card and coupons to purchase brand-name versions. It never hurts to ask your pharmacist to try BuzzRx when filling or refilling any of your prescription drugs—whether you have insurance or not.

What is the price of sotalol with insurance?

Ask your pharmacist or insurance provider for your copay price on sotalol—Copay amounts vary depending on the type of insurance plan you have and if there is a deductible to reach before prescription drug coverage begins.

You could save up to 80% on your prescription medication with a free BuzzRx discount coupon for sotalol. When using the BuzzRx lookup tool to find the price of your medicine, be sure to enter the correct dosage, form, and quantity to receive the most accurate discounted pricing. It never hurts to ask your pharmacist to try BuzzRx when filling or refilling any of your prescriptions—whether you have insurance or not.

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