What is Sotalol Hydrochloride?
Used to suppress and prevent recurrence of documented life-threatening ventricular arrhythmias (e.g., sustained ventricular tachycardia); designated an orphan drug by FDA for such use.
Shown to be effective in patients with life-threatening ventricular arrhythmias (e.g., sustained ventricular tachycardia or fibrillation) as well as those with less severe arrhythmias (e.g., premature ventricular complexes [PVCs], paired PVCs, nonsustained ventricular tachycardia)
Although antiarrhythmic drugs, including sotalol, may suppress the recurrence of arrhythmias and improve symptoms, there is no evidence from randomized controlled studies indicating that these drugs have a beneficial effect on mortality or sudden death.
Because of arrhythmogenic potential, lack of evidence for improved survival, and risk of serious adverse effects (see Proarrhythmic Effects under Cautions), use in patients with less severe arrhythmias, even if symptomatic, generally not recommended.
Avoid treatment of asymptomatic PVCs.
Not a first-line drug of choice during cardiac arrest, but may be used for treatment of hemodynamically stable sustained monomorphic ventricular tachycardia; included in current ACLS guidelines for adult tachycardia.
Supraventricular Arrhythmias
Used to maintain normal sinus rhythm in patients with symptomatic atrial fibrillation or flutter who are currently in sinus rhythm.
Because of potential for life-threatening ventricular arrhythmias, reserve use for highly symptomatic atrial fibrillation/flutter. (See Proarrhythmic Effects under Cautions.) Do not use in patients with easily reversible (e.g., with Valsalva maneuver) paroxysmal atrial fibrillation.
Efficacy in preventing atrial fibrillation or flutter recurrences is comparable to that of quinidine or propafenone and less than that of amiodarone.
Also has been used for treatment of other supraventricular tachycardias (SVTs), including paroxysmal supraventricular tachycardia (PSVT) due to AV nodal reentry tachycardia (AVNRT) or AV reentry tachycardia (AVRT).