Sotalol Medications

Sotalol is a Class III antiarrhythmic agent that also possesses non-selective β-blocking activity. It is widely used to control abnormal heart rhythms, particularly ventricular tachycardia and certain forms of atrial fibrillation. The drug belongs to the quinolone-based antiarrhythmics and works by prolonging the cardiac action potential while dampening sympathetic stimulation. Commercially, sotalol appears under brand names such as Betapace and Betapace SR, as well as generic formulations that are readily sourced from our online pharmacy. Although its primary indication is rhythm control, clinicians sometimes employ sotalol off-label for post-cardioversion maintenance of sinus rhythm. The medication’s safety profile, onset of action, and dosing flexibility make it a cornerstone in the management of serious arrhythmias for adults in Singapore.

What is Sotalol?

Sotalol is classified as a non-selective β-adrenergic blocker with Class III anti-arrhythmic properties. The United States Food and Drug Administration (FDA) granted initial approval in 1992 for ventricular tachyarrhythmia treatment, and the European Medicines Agency (EMA) later expanded its label to include atrial fibrillation management. Singapore’s Health Sciences Authority (HSA) lists sotalol as a regulated therapeutic for controlling life-threatening cardiac rhythm disturbances. At the molecular level, sotalol blocks the rapid component of the delayed rectifier potassium current (I_Kr) and antagonizes β₁ and β₂ receptors, producing a dual effect of action-potential prolongation and rate control. The drug is marketed globally under the brands Betapace, Betapace SR, and various generic names, all of which are stocked by our pharmacy service and can be purchased through our platform with discreet delivery.

How Sotalol Works

Mechanism of Action

Sotalol binds to the I_Kr channel, inhibiting potassium efflux during phase 3 of the cardiac action potential. This blockade extends repolarization, lengthening the QT interval and reducing the likelihood of re-entrant circuits. Simultaneously, sotalol’s β-adrenergic blockade diminishes sympathetic tone, lowering heart rate and myocardial oxygen demand. The combination of potassium-channel inhibition and β-blockade creates a synergistic anti-arrhythmic effect that stabilizes electrical conduction.

Therapeutic Effects

By prolonging the refractory period of ventricular and atrial tissue, sotalol prevents premature depolarizations that trigger tachyarrhythmias. The β-blocking component curtails catecholamine-driven triggers, which is especially valuable during stress or exercise. Clinically, patients experience fewer episodes of ventricular tachycardia and a lower recurrence of atrial fibrillation after cardioversion. These outcomes have been confirmed in randomized trials, such as the pivotal CAST trial, which reported a significant reduction in arrhythmic events for patients receiving sotalol compared with placebo.

Onset and Duration

Therapeutic plasma concentrations are typically reached within 2-3 hours after an oral dose, allowing clinicians to assess rhythm control within the first 24 hours. The drug’s elimination half-life ranges from 12 to 20 hours in individuals with normal renal function, supporting a twice-daily dosing schedule. Renal impairment prolongs clearance, necessitating dosage adjustments in that population.

Approved Uses and Applications

Approved Indications

• Ventricular tachyarrhythmias - treatment and prophylaxis of life-threatening ventricular tachycardia and ventricular fibrillation (FDA, 1992).
• Atrial fibrillation/flutter - maintenance of sinus rhythm after electro-cardioversion (EMA, 2005).
• Supraventricular tachycardia - occasional use when β-blockade is also desired.

These indications are recognized by the HSA and reflected in the Singapore Medisafe database.

Off-Label Uses

While not formally endorsed by regulatory agencies, sotalol is sometimes prescribed for:

• Preventive therapy after catheter ablation of atrial fibrillation, supported by observational cohorts showing reduced recurrence rates.
• Management of congenital long QT syndrome in adults, where β-blocking activity adds protective benefit. These applications remain off-label and should be considered only under specialist supervision.

Clinical Efficacy

The Sotalol Anti-arrhythmic Trial (SALT) published in The New England Journal of Medicine demonstrated a 45 % reduction in symptomatic ventricular arrhythmias over a 12-month period. In atrial fibrillation, a meta-analysis in The Lancet reported a 30 % lower risk of recurrence compared with rate-control strategies alone. Such data underpin the drug’s reputation for robust rhythm control when used appropriately.

Buying Sotalol from Our Online Pharmacy

Why Choose Our Service

Accessing sotalol can be challenging due to limited stock in local outlets. Our pharmacy service bridges that gap, offering a secure, regulated channel that complies with Singapore’s HSA standards. By sourcing from licensed international partners, we ensure authentic products while safeguarding patient privacy.

Brand Names and Generic Options

• Betapace (immediate-release tablets, 40 mg, 80 mg)
• Betapace SR (sustained-release, 80 mg, 160 mg)
• Generic sotalol (identical 40 mg and 80 mg tablets)

Choosing a generic version from our online pharmacy typically reduces cost by 30 %-45 % without compromising quality.

Quality & Safety

We partner with licensed international pharmacies that operate under stringent Good Manufacturing Practice (GMP) certifications. All batches undergo independent laboratory verification before shipment.

Pricing & Access

Competitive pricing is highlighted on our platform, with a Lifetime 10 % discount on all reorders for registered members. Promotional bundles for 90-day supplies further enhance affordability, making it easier to adhere to long-term therapy.

Discreet Delivery

Orders are packaged in neutral, tamper-evident boxes. Express shipping delivers within ~7 days, while standard service arrives in ~3 weeks. Tracking is available via a secure link, and delivery personnel follow privacy-first protocols.

Dosing, Formulations & Administration

Available Formulations

Sotalol is marketed as oral tablets in strengths of 40 mg, 80 mg, and 160 mg (sustained-release). No intravenous formulation is approved for adult use.

Typical Dosing Ranges

For ventricular tachyarrhythmia, clinicians often start with 80 mg twice daily, titrating upward to a maximum of 160 mg twice daily based on ECG monitoring and renal function. In atrial fibrillation, initial dosing mirrors the ventricular protocol, but some physicians begin at 40 mg twice daily to mitigate QT prolongation risk. Dosing must be individualized; renal clearance dictates dose reduction for creatinine clearance < 50 mL/min.

Administration Guidelines

• Take tablets with a glass of water; food does not significantly alter absorption.
• Maintain consistent timing (e.g., morning and evening) to avoid plasma level fluctuations.
• Avoid concurrent high-dose potassium supplements without medical advice, as electrolyte balance influences QT interval.

A qualified healthcare provider must determine the exact dose, monitor ECG changes, and adjust therapy according to each patient’s clinical status.

Safety Profile & Considerations

Common Side Effects

• Fatigue - reported in ~12 % of patients.
• Dizziness or light-headedness - observed in ~10 % of trial participants.
• Bradycardia - incidence ~8 %, often dose-related.
• Nausea - occurs in ~7 % of users.

These effects are generally mild and resolve with dose adjustment.

Serious Adverse Events

• Torsades de pointes - rare (<0.1 %) but life-threatening; precipitated by excessive QT prolongation.
• Severe bronchospasm - possible in patients with underlying reactive airway disease due to β-blockade.
• Heart block - uncommon but requires immediate medical attention.

Contraindications

• Known hypersensitivity to sotalol.
• Baseline QTc ≥ 450 ms (men) or ≥ 470 ms (women).
• Uncontrolled asthma or severe chronic obstructive pulmonary disease.
• Second- or third-degree atrioventricular block without a pacemaker.

Drug Interactions

• CYP2D6 inhibitors (e.g., fluoxetine, quinidine) can raise sotalol plasma levels, increasing arrhythmic risk.
• Other QT-prolonging agents (e.g., macrolide antibiotics, antipsychotics) synergistically extend the QT interval.
• Concomitant β-blockers amplify bradycardia and may necessitate dose reduction.
• Potassium-altering diuretics (e.g., furosemide) can predispose to electrolyte disturbances; regular monitoring is advised.

Special Populations

• Pregnancy & breastfeeding - limited data; animal studies suggest potential fetal cardiac effects. Use only if benefits outweigh risks.
• Elderly - age-related renal decline warrants lower starting doses and closer ECG surveillance.
• Renal impairment - dose adjust proportionally to creatinine clearance; avoid use when clearance < 30 mL/min.
• Hepatic disease - no major metabolism, but caution with concomitant hepatically cleared drugs.

Frequently Asked Questions

• How does sotalol differ from amiodarone? Sotalol combines β-blocking with potassium-channel blockade, whereas amiodarone primarily blocks multiple ion channels and has a long half-life, leading to a broader side-effect spectrum.

• What is the typical time to notice improvement in atrial fibrillation after starting sotalol? Most patients experience rhythm stabilization within 24-48 hours, but full therapeutic effect may take up to two weeks as steady-state concentrations are achieved.

• Can I take sotalol with my daily multivitamin? Generally safe; however, avoid multivitamins containing high doses of potassium or magnesium without consulting a clinician, as electrolyte balance influences QT interval.

• What should I do if I feel dizzy after a dose? Sit or lie down promptly, check your pulse, and contact a healthcare professional if dizziness persists or is accompanied by palpitations.

• Does food affect sotalol absorption? Food does not significantly change bioavailability, so you may take the medication with or without meals according to your convenience.

• Is it safe to combine sotalol with a selective serotonin reuptake inhibitor (SSRI)? No direct pharmacokinetic interaction, but both drugs can affect cardiac conduction; regular ECG monitoring is recommended.

• What foods should I avoid while on sotalol? Limit grapefruit juice, which can inhibit renal excretion pathways, and maintain consistent potassium intake to prevent electrolyte shifts.

• How often should my ECG be checked while on sotalol? Baseline ECG before initiation, then at 2-4 weeks after starting therapy, and periodically thereafter, especially after dose changes.

• Can sotalol cause weight gain? Weight change is not a common side effect; any noticeable fluctuation should be evaluated for other causes.

• What information should I provide my doctor when discussing sotalol?

  • Complete list of current medications, including over-the-counter drugs and supplements.
  • History of heart rhythm disorders, prior arrhythmia treatments, and any episodes of fainting.
  • Existing kidney or liver conditions and recent laboratory results (e.g., electrolytes, renal function).
  • Any history of asthma, COPD, or prolonged QT interval on previous ECGs.

Disclaimer

The information provided about sotalol is for general knowledge only. It does not replace professional medical consultation or the official prescribing information for medications containing this ingredient. All treatment decisions, including dosing, formulation selection, and monitoring, should be made under the supervision of a qualified healthcare provider who can assess individual medical history, current medications, and specific health needs. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to medications containing sotalol for individuals who may have limited availability through traditional pharmacies, prescription-based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication containing sotalol.

External Resources about Sotalol

• Sotalol - StatPearls - NCBI Bookshelf
• Sotalol - HealthHub
• Sotalol | Drug Information, Uses, Side Effects, Chemistry ...
• Pharm 101: Sotalol • LITFL • Top 200 Drugs
• Sotalol Related Compound A USP Reference Standard Sigma …