Sotalol

General Toxicity Notes
Blood levels most often the best guide to therapy. Half-life may be prolonged in heart failure or with reduced hepatic blood flow.
Excreted Unchanged %
80-90
Half-Life (Normalesrd) Hours
10-20/56
Plasma Protein Binding %
<1
Volume Of Distribution L/Kg
1.2-2.4
Dose For Normal Renal Function
80 mg q12h
Second Dose
Second Dose: 120-160 q12h
Adjustment For Renal Failure Method
I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
q12h [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
q24-48h [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
q48-72h [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose after dialysis, [D]
Supplement For Dialysis [Recommendation Level]: Pd
PD: None, [D]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, titrate, [D]
References
Berglund G, Descamps R, Thomis JA. Pharmacokinetics of sotalol after chronic administration to patients with renal insufficiency. Eur J Clin Pharmacol. 1980; 18: 321-6. [PMID: 7439252] / Blair AD, Burgess ED, Maxwell BM, Cutler RE. Sotalol kinetics in renal insufficiency. Clin Pharmacol Ther. 1981; 29: 457-63. [PMID: 7471612] / Dumas M, d&#146; Athis P, Besancenot JF, Chadoint-Noudeau V, Chalopin JM, Rifle G, et al. Variations of sotalol kinetics in renal insufficiency. Int J Clin Pharmacol Ther Toxicol. 1989; 27: 486-9. [PMID: 2583875] / Fitton A, Sorkin EM. Sotalol. An updated review of its pharmacological properties and therapeutic use in cardiac arrhythmias. Drugs. 1993; 46: 678-719. [PMID: 7506652] / Hanyok JJ. Clinical pharmacokinetics of sotalol. Am J Cardiol. 1993; 72: 19A-26A. [PMID: 8346722] / Sundquist HK, Anttila M, Forsstr&#246; m J, Kasanen A. Serum levels and half-life of sotalol in chronic renal failure. Ann Clin Res. 1975; 7: 442-6. [PMID: 1211858] / Tjandramaga TB, Verbeeck R, Thomas J, Verbesselt R, Verberckmoes R, Schepper PJ. The effect of end-stage renal failure and haemodialysis on the elimination kinetics of sotalol. Br J Clin Pharmacol. 1976; 3: 259-65. [PMID: 973960]
Toxicity Notes
Extreme caution should be exercised in the use of sotalol in patients with renal failure undergoing hemodialysis. To minimize the risk of induced arrhythmia, patients initiated or re-initiated on sotalol should be placed for a minimum of 3 days (on their maintenance dose) in a facility that can provide cardiac resuscitation and continuous electrocardiographic monitoring.