SotalolSotalol Hydrochloride

About Sotalol

Sotalol is a beta blocker that also lengthens the heart’s electrical recovery period, making it a class III antiarrhythmic. The label covers documented, life-threatening ventricular arrhythmias and the maintenance of normal rhythm in highly symptomatic atrial fibrillation or flutter. Betapace and Betapace AF now share one label, with light-blue and white tablets respectively, and generics are sold both as plain sotalol and as sotalol AF.

The boxed warning is for life-threatening proarrhythmia: sotalol can itself cause a dangerous ventricular rhythm linked to a longer QT interval. It is therefore started, or restarted, in a facility with continuous ECG monitoring and resuscitation for at least three days, and the prescriber calculates kidney function first, because the drug leaves through the kidneys and the gap between doses stretches from every 12 hours to every 24 or longer as kidney function falls. If the QT interval reaches 500 milliseconds, the dose is cut, the interval lengthened or the drug stopped.

It is not used with a slow resting heart rate, sick sinus syndrome, heart block without a pacemaker, long QT syndrome, low potassium, cardiogenic shock, uncontrolled heart failure or asthma. Fatigue, a slow heartbeat, breathlessness and dizziness are common. It is not stopped suddenly: the label calls for a gradual reduction over one to two weeks, because abrupt withdrawal can bring on angina or a heart attack. Sotylize, a 5 mg per mL oral solution with the same uses and boxed warning, is dosed by weight in children; an injection is used in hospitals.

Taking Sotalol

How to take it

Usually every 12 hours, or less often with reduced kidney function, exactly as set during the monitored start. A meal lowers absorption a little, so take it the same way each time, always with food or always without.

If you miss a dose

Take it as soon as you remember unless it is almost time for the next dose; then skip it. Never double a dose or shorten the gap between doses.

Storage

At room temperature, tightly closed, away from heat and moisture, out of reach of children; the same for the oral solution.

Interactions to know about

Other antiarrhythmics and QT-prolonging drugs, including some antibiotics, antidepressants and antipsychotics, are avoided with it. Digoxin, diltiazem and verapamil add to the slowing of the heart. It can hide low blood sugar, so diabetes treatment may need adjusting. Take aluminum or magnesium antacids at least two hours apart from it, and the label advises against breastfeeding.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Sotalol differs from pharmacy to pharmacy

Generic sotalol costs pharmacies little, so the cash price is mostly the dispensing fee and markup, which differ widely between pharmacies. A month is sixty tablets, and a pharmacy that prices per tablet quotes more than one with a flat-price generic list. The 240 mg tablet and the AF-labeled generics have fewer makers and may need to be ordered.

A prescription that names Betapace without allowing substitution is quoted at brand price, and Sotylize has no generic, so anyone who needs the liquid pays a brand price.

Ways to pay less for Sotalol without insurance

• Ask the prescriber to write sotalol, or to allow generic substitution.
• Ask whether sotalol is on the pharmacy’s flat-price generic list and whether your strength is in stock.
• Once the dose is settled, ask for a ninety-day prescription.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Sotalol

1. 1.Is this plain sotalol or the AF version, and does my prescription allow either?
2. 2.How far apart should I keep it from antacids?
3. 3.Which symptoms, such as fainting or a racing heartbeat, need urgent help?
4. 4.Does it interact with my other heart, diabetes or asthma medicines?

Related medications