Sotalol

Drug Type Anti-arrhythmic

Indication
Action

Beta adrenergic blocking with type 3 anti arrhythmic activity for the treatment of supra
ventricular arrhythmia (SVT) after consultation with a cardiologist.
Its beta adrenergic activity causes a reduction in heart rate and a limited reduction in the force of
contraction. This leads to a decrease in myocardial oxygen consumption and cardiac work. The
anti arrhythmic activity of sotolol causes a prolongation of the action potential in cardiac tissue
by delaying repolarisation.

Presentation Oral suspension: 5mg/ml suspension (prepared by pharmacy)

Intravenous ampoule: 10mg / ml

Oral suspension: 1 to 2mg /kg/dose 12th hourly.

If necessary, can increase to maximum of 4mg/kg/dose 12th hourly.

Dose

Intravenous: 0.5 to 1.5mg/kg/dose 12th hourly by slow IV infusion over 10 minutes.

Dilution For intravenous preparation dilute 10mg / ml with normal saline 0.9% to make a 5ml solution that
is a concentration of 2mg/ml

Administration

Oral: The medication should preferably be administered on an empty stomach at least 30

minutes before feeding. This practice can vary according to the frequency of feeding and
practical issues relating to some problematic feeders. Intravenous: via peripheral or central
cannula.

Compatible

The cannula should be flushed with normal saline pre and post administration of sotolol.

Interactions

Sotolol can exacerbate existing arrhythmias or cause new arrhythmias including: Torsades de
Pointes, AV block, and ventricular ectopic beats. Other adverse effects include: hypertension,
bradycardia, rash and dyspnoea. Vomiting and diarrhoea have been reported. Signs of
hypoglycaemia may be masked by sotolol.

Side Effects Elimination is primarily by the kidneys with 75% of a dose excreted unchanged in the urine. As
sotalol is primarily excreted by the kidneys, dosage adjustment is necessary in patients with
moderate renal impairment. Severe renal impairment is a contraindication.
Sotolol should not be used when there is shock (cardiogenic or hypovolaemia), congestive
cardiac failure, sinus bradycardia, heart block, congenital or acquired long QT syndromes,
hypokalaemia or hypomagnesaemia.
Consultation with a paediatric cardiologist should be sought before concomitant therapy with
amiodarone (cordarone X), diuretics, flecainide or chlorpromazine (largactil)

Contraindications
Other Considerations Special Considerations:
Infant should be on cardio respiratory monitor. During intra venous administration observe for
return of sinus rhythm. Observe QT interval. Caution if QT becomes prolonged especially with
increased dosage
During intravenous administration have the resuscitation equipment nearby and atropine should
be available for profound bradycardia
Atropine
1. 10-30 micrograms/kg/dose IV over 1 minute.
2. Dose may be repeated every 10-15 minutes to achieve desired effect, with a maximum total
dose of 40 micrograms/kg.
Also monitor: electrolytes, especially potassium and magnesium

References

References King Edward memorial Hospital (2011). Neonatal Medication Protocols

http://www.kemh.health.wa.gov.au/services/nccu/guidelines/drug_protocols/Sotalol.pdf.
Accessed June 2011
National Womens Hospital Newborn Services (2005). Drug Protocols Sotolol hydrochloride.
Auckland http://www.adhb.govt.nz/newborn/DrugProtocols/AdenosinePharmacology.htm
Accessed June 2011
NSW Health (2010) Clinical Information Access Programme MIMS Online Sotolol
hydrochloride. Accessed June 2011
Saul JP, Schaffer MS, karpawich PP, Erickson CC, Epstein MR et al. Single dose
pharmacokinetics of sotolol in a pediatric population with supra ventricular and / or ventricular
tachyarrythmia. The Journal of Clinical Pharmacology, 2001: 41,1;35. http://jcp.sagepub.com
Accessed July 2011.