Sotalol (Betapace Af) Risks, Warnings, and Complications

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.