Generic Name: sotalol, Oral tablet

Generic Name:

sotalol, Oral tablet

BETAPACE,Sorine

All Brands

  • BETAPACE
  • Sorine
SECTION 1 of 5

Highlights for sotalol

Oral tablet
1

Sotalol is an antiarrhythmic drug used to treat ventricular arrhythmia. Sotalol AF is used to treat atrial fibrillation or heart flutter.

2

Sotalol and sotalol AF can’t be substituted for one another. They have differences in dosing, administration, and safety. Make sure you know which sotalol product you’re taking.

3

Your treatment with this drug will begin and any dosage increases will take place in a setting where your heart rhythm can be monitored.

4

Common side effects include low heart rate, shortness of breath, tiredness, nausea, dizziness/light headedness, and weakness.

5

This medication can cause or worsen a condition called Torsades de Pointes. This is a potentially dangerous abnormal heart rhythm that originates in the heart’s ventricles. Get emergency medical help if you feel an irregular heartbeat while taking sotalol.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Administration warning. If you start or restart this medication, you should be in a facility that can provide continuous heart monitoring and kidney function tests for at least 3 days on the maintenance dose. This will help to minimize the risk of sotalol causing heart rhythm problems. Clinicians in the facility need to have experience in treating heart emergencies.

Substitution warning. Sotalol and sotalol AF can’t be substituted for one another. They have differences in dosing, administration, and safety.

Heart rhythm warning

This medication can cause or worsen a condition called Torsades de Pointes. This is a potentially dangerous abnormal heart rhythm that originates in the heart’s ventricles. Get emergency medical help if you feel an irregular heartbeat while taking sotalol.

You’re at increased risk if:

  • your heart isn’t working well
  • you have low heart rate and potassium levels
  • you’re female
  • you have a history of heart failure
  • you have a rapid heartbeat that lasts longer than 30 seconds
  • you have poor kidney function
  • you’re taking larger doses of sotalol

Kidney health warning

Sotalol is primarily removed from your body through your kidneys. If you have kidney problems, your dose of this medicine will need to be lowered.

Warning for stopping

Suddenly stopping this medication can lead to worse chest pain, heart rhythm problems, or even heart attacks. You’ll need to be closely monitored when stopping this medicine. You may receive a different beta blocker, especially if you have coronary artery disease. Your dose will be gradually lowered.

Drug Features

Sotalol is a prescription drug. It’s available as an oral tablet.

It’s also available in a generic version. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

If you’re taking sotalol AF to treat irregular heartbeat, you’ll take it along with a blood thinning medication (anticoagulant).

Why It's Used

This medication is used to treat:

  • ventricular arrhythmia (sotalol)
  • atrial fibrillation and atrial flutter (sotalol AF)

How It Works

Sotalol belongs to a class of drugs called antiarrhythmics. It works by reducing abnormal heart rhythms. It also helps blood vessels to relax, which may help your heart work better.

SECTION 2 of 5

sotalol Side Effects

Oral tablet

Most Common Side Effects

The most common side effects that occur with sotalol include:

  • low heart rate

  • shortness of breath

  • tiredness

  • nausea

  • dizziness or lightheadedness

  • weakness

Serious Side Effects

If you experience any of the following serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • heart problems, including:

    • chest pain
    • irregular heartbeat (Torsades de Pointes)
    • slow heart rate
  • gastrointestinal problems, including:

    • vomiting
    • diarrhea
  • allergic reactions, including:

    • difficulty breathing or wheezing
    • skin rash
  • cold, tingling, or numbness in your hands or feet

  • confusion

  • muscle aches and pains

  • sweating

  • swollen legs or ankles

  • tremor, shakes

  • loss of appetite or feeling unusually thirsty

Pharmacist's Advice
Healthline Pharmacist Editorial Team

Sotalol may cause drowsiness. Don’t drive, operate machinery, or perform any activities that require mental alertness until you know how this drug affects you.  

Mild side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

sotalol May Interact with Other Medications

Oral tablet

Sotalol can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol Interaction

Combining alcohol and sotalol can make you more drowsy and dizzy. It can also lead to abnormally low blood pressure. Avoid alcoholic drinks while taking this medicine.

Medications That Might Interact with This Drug

Multiple sclerosis drug
  • fingolimod

Combining this drug with sotalol may make your heart condition worse or lead to an irregular heart rate called Torsades de Pointes.

Heart drugs
  • digoxin

Be careful when taking digoxin with sotalol. Taking these drugs together can decrease heart rate and slow heart conduction. It can also cause new or more frequent occurrence of pre-existing heart rhythm abnormalities.

Beta blockers. Examples are:

  • metoprolol
  • nadolol
  • atenolol
  • propranolol

Don’t use sotalol with another beta blocker. This may lower your heart rate and blood pressure too much.

Antiarrhythmics (including class IA and class III antiarrhythmics). Examples are:

  • amiodarone
  • dofetilide
  • disopyramide
  • quinidine
  • procainamide
  • bretylium
  • dronedarone

Combining these drugs with sotalol increases your risk of heart problems. If you’re going to start sotalol, these other medicines should be carefully stopped beforehand.

Blood pressure drugs
  • clonidine

Be careful if you’re stopping clonidine while taking sotalol. Stopping clonidine may lead to decreased blood pressure.

If sotalol is replacing clonidine, your dose of clonidine may be lowered slowly. Your dose of sotalol may be increased slowly. This will help to manage your blood pressure best.

Calcium channel blockers. Examples are:

  • diltiazem
  • verapamil

Be careful when taking these medications with sotalol. They can increase side effects, such as lower than normal blood pressure.

Catecholamine-depleting drugs. Examples are:

  • reserpine
  • guanethidine

Be careful when taking these drugs with sotalol. You will need to be closely monitored for low blood pressure and low heart rate that can cause a temporary lapse in consciousness.

Diabetes drugs
  • glipizide
  • glyburide

Sotalol can cover up the symptoms of low blood sugar, and it can cause high blood sugar. Your doses of diabetes medication that cause a low sugar reaction will need to be changed if you’re taking them with sotalol. 

Drugs to improve breathing
  • albuterol
  • terbutaline
  • isoproterenol

Combining these drugs with sotalol may make them less effective.

Certain antacids

Aluminum hydroxide and magnesium hydroxide containing antacids:

  • Mylanta
  • Mag-al
  • Mintox
  • Many over-the-counter liquid antacids
  • cisapride (gastrointestinal reflux disease drug)

Avoid taking sotalol within 2 hours of taking these antacids. Taking them too close together lowers the amount of sotalol in your body and decrease its effect.

Mental health drugs
  • thioridazine
  • pimozide
  • ziprasidone
  • tricyclic antidepressants. Examples are:
    • amitriptyline (Elavil)
    • amoxapine (Asendin)
    • clomipramine (Anafranil)
    • desipramine (Norpramin)
    • doxepin (Sinequan)

Combining these drugs with sotalol may make your heart condition worse or lead to an irregular heart rate called Torsades de Pointes.

Antibiotics
  • oral macrolides:
    • erythromycin
    • clarithromycin
  • quinolones:
    • ofloxacin
    • ciprofloxacin
    • gemifloxacin
    • levofloxacin
    • moxifloxacin

Combining these drugs with sotalol may make your heart condition worse or lead to an irregular heart rate called Torsades de Pointes.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with heart problems

Don’t take this medication if you have:

  • heart rate lower than 50 beats per minute during waking hours
  • second or third degree heart block (unless a functioning pacemaker is in place)
  • a heart rhythm disorder that can cause fast, chaotic heartbeats
  • cardiogenic shock
  • uncontrolled heart failure
  • baseline measure in the heart’s electrical cycle (QT interval) of more than 450 msec

Be careful taking sotalol if you have heart failure that’s being treated by digoxin or diuretics. The medication can make your heart failure worse.

If you have abnormal heart rhythm that starts in the ventricles (Torsades de Pointes), sotalol can make it worse.

Take caution if you have life-threatening heart rhythms that started in the ventricles after a recent heart attack. This drug may increase your risk of death short term (14 days) or can increase your risk of dying later.

This medication can cause low heart rate in people with heart rhythm problems due to improper electrical activity in the heart.

Be very careful taking sotalol if you have a heart rhythm problem called sick sinus syndrome. It can cause lower than normal heart rate or stopping of your heart.

People with asthma

If you have asthma, taking sotalol can make your condition worse and decrease how well your asthma medications work. Don’t take sotalol if you have asthma.

People with electrolyte disturbances

Don’t take sotalol if you have low potassium or low magnesium levels. This can increase the time between part of your heart’s electrical cycle and increase your risk for a heart condition called Torsades de Pointes.

People with airway tightening

This is non-allergic tightening, and includes chronic bronchitis and emphysema. If you have trouble breathing, you generally shouldn’t take sotalol or other beta blockers. If you have to use this medicine, use the smallest effective dose.

People with life-threatening allergies

If you have a history of getting severe life-threatening allergic reactions to a variety of allergens, you’re at a higher risk of developing the same response to beta blockers. You may not respond to the usual dose of epinephrine that’s used to treat an allergic reaction.

People with major surgery

If you’re going in for a major surgery, tell your doctor you’re taking sotalol. Your doctor may keep you on it, but they’ll need to know if you’re taking the drug. It can cause severe low blood pressure and difficulty in restoring normal heart rhythm.

People with diabetes or low blood sugar

Sotalol can mask the symptoms of low blood sugar. Be careful if you’re taking this medicine. Your diabetic medications might need to be changed.

People with hyperactive thyroid

Sotalol can mask the symptoms of a hyperactive thyroid (hyperthyroidism). If you suddenly stop taking this medicine and have hyperthyroidism, your symptoms can get worse or you may get a condition called thyroid storm.

People with kidney dysfunction

Sotalol is primarily cleared from your body through your kidneys. If you have kidney problems, the drug might build up in your body, which can lead to side effects. If you have kidney problems, your dose of this medicine will need to be lowered. 

Don’t use sotalol if you have severe kidney problems.

Pregnant women

Sotalol is a pregnancy category B drug. That means two things:

  1. Studies of the drug in pregnant animals haven’t shown risk to the fetus.
  2. There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Sotalol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women who are nursing

Sotalol may pass through breast milk and cause side effects in a breastfeeding baby.

Tell your doctor if you’re breastfeeding. You may need to decide whether to breastfeed or take sotalol.

For Children

The effectiveness and safety of this drug haven’t been established in people younger than 18 years old.

When to call the doctor

Tell your doctor that you’re taking this drug if you’re going in for a major surgery. You may stay on the drug, but your doctor needs to know if you take it. It can cause severe low blood pressure and difficulty in restoring normal heart rhythm.

Allergies

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

If you have a history of getting severe life-threatening allergic reactions to a variety of allergens, you’re at a higher risk of developing the same response to beta blockers. You may not respond to the usual dose of epinephrine that’s used to treat an allergic reaction.

SECTION 4 of 5

How to Take sotalol (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Ventricular arrhythmia (sotalol)
Form: Oral tablet
Strengths: 80 mg, 120 mg, and 160 mg
Adult Dosage (ages 18 years and older)
  • The recommended starting dose is 80 mg taken two times per day.
  • Your dose can be gradually increased. Three days are needed between dosage changes in order to monitor your heart and for enough medicine to be in your body to treat the arrhythmia (steady state).
  • Your total daily dose can be increased to 240 or 320 mg per day. This would be the same as 120 to 160 mg taken two times per day.
  • You might require higher doses of 480–640 mg per day if you have life-threatening heart rhythm problems. This high dose should only be given when the benefit exceeds the risk of side effects.
Child Dosage (ages 2-17 years)
  • The dose is based on body surface area in children.
  • The recommended starting dose is 30 mg/m2 taken three times per day (90 mg/m2 total daily dose). This is approximately equal to the 160 mg per day dose for adults.
  • Your dose can gradually be increased. Three days are needed between dosage changes in order to monitor your heart and for enough medicine to be in your body to treat the arrhythmia.
  •  Increasing doses is based on clinical response, heart rate, and heart rhythm. 
  • Your child’s dose can be increased to a maximum of 60 mg/m2 (approximately equal to the 360 mg per day dose for adults). 
Child Dosage (ages 0-2 years)
  • Dosing for children younger than 2 years old is based on age in months. Your doctor will calculate your dose. 
  • The total daily dose should be given three times per day.
Special Considerations

Kidney dysfunction: Reduced kidney function can cause this drug to build up in your body. If you have kidney problems, your dose of sotalol will need to be lower.

Warnings

Sotalol should be started and doses increased in a setting where your heart rhythm and heart rate can be monitored continuously.

Atrial fibrillation or atrial flutter (sotalol AF)
Form: Oral tablet
Strengths: 80 mg, 120 mg, and 160 mg
Adult Dosage (ages 18 years and older)
  • The recommended starting dose is 80 mg. The number of times this dose is taken will depend on your kidney function.
  • After that, the dose may gradually be increased from 80 mg once or twice daily to a maximum of 160 mg once or twice daily depending upon kidney function.

How often you take sotalol AF depends on your kidney function (creatinine clearance; CrCl).

  • CrCl over 60 mL/min: The dose is taken two times per day.
  • CrCl between 40–60 mL/min: The dose is given once per day or the total daily dose is divided in half and taken two times per day.
  • CrCl lower than 40 mL/min: Sotalol can’t be used.

When increasing doses, the same steps while starting the medicine need to be followed.

  • You’ll be monitored for a minimum of 3 days on the maintenance dose.
  • You shouldn’t be discharged from the hospital within12 hours of converting to a normal heart rate.
Child Dosage (ages 2-17 years)
  • The dose is based on body surface area in children.
  • The recommended starting dose is 30 mg/m2 taken three times per day (90 mg/m2 total daily dose). This is approximately equal to the 160 mg per day dose for adults.
  • Your dose can gradually be increased.
  • Three days are needed between dosage changes in order to monitor your heart and for enough medicine to be in your body to treat the arrhythmia.
  • Increasing doses is based on clinical response, heart rate, and heart rhythm.
  • Your child’s dose can be increased to a maximum of 60 mg/m2 (approximately equal to the 360 mg per day dose for adults).
Child Dosage (ages 0-2 years)
  • Dosing for children younger than 2 years old is based on age in months. Your doctor will calculate your dose.
  • The total daily dose should be given three times per day.
Special Considerations

Kidney dysfunction: Reduced kidney function can cause this drug to build up in your body. If you have kidney problems, your dose of sotalol will need to be lower.

Warnings

Sotalol should be started and doses increased in a setting where your heart rhythm and heart rate can be monitored continuously.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Sotalol comes with risks if you don’t take it as prescribed by your doctor.

If You Stop Taking It Suddenly

Suddenly stopping sotalol can lead to worse chest pain, heart rhythm problems, or even heart attacks.

When you stop taking this medication, you’ll need to be closely monitored and consider using an alternate beta blocker, especially if you have coronary artery disease.

If You Take Too Much

If you think you’ve taken too much, go to the emergency room or contact the poison control center. The most common signs of overdose are lower than normal heart rate, heart failure, low blood pressure, low blood sugar, and problems breathing due to tightening of the airways in your lungs.

What to Do If You Miss a Dose

If you miss a dose, take the next dose at the usual time. Don’t double the next dose.

How to Tell If the Drug Is Working

You may be able to tell this drug is working if your heart rate returns to normal and your heart rate is lower.

Sotalol is a long-term drug treatment.

Take this drug in evenly spaced doses

If you’re taking it two times per day, make sure to take it every 12 hours.

If you’re giving this medicine to a child three times a day, make sure to give it every 8 hours.

Store at room temperature

Store sotalol AF in temperatures from 68–77°F (20–25°C). Keep it in a tight, light-resistant container.

Store regular sotalol at 77°F (25°C). You can store it for a short time in temperatures as low as 59°F (15°C) and as high as 86°F (30°C).

Note: Keep your drugs away from areas where they could get wet, such as bathrooms. Store them away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show your pharmacy’s preprinted label clearly identifying the medication. Keep the original prescription-labeled box with you when traveling.

Clinical Monitoring

Your doctor may monitor your:

  • kidney function
  • heart function or rhythm
  • blood sugar
  • blood pressure or heart rate
  • electrolytes (potassium, magnesium)
  • thyroid function

Not every pharmacy stocks this drug, so call ahead

This medicine can’t be stopped once you leave the hospital.

Insurance

Insurance companies may require prior authorization before they pay for the brand name drug. The generic will probably not need a prior authorization.

Are There Any Alternatives?

There are other medicines available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

What does the pill look like?

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SECTION 5 of 5

How Much Does sotalol Cost?

Oral tablet
We've partnered with GoodRX so you can compare prices and save money on your next prescription. Check out the lowest cash prices below and enter your zip code to find the best deal near you.

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Lowest price for sotalol

Walmart $8.00
Kroger Pharmacy $8.00
Target $8.00
These represent the lowest cash prices for sotalol and may be lower than your insurance.

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These represent the lowest cash prices for sotalol and may be lower than your insurance.

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on June 29, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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