Sotalol

drugbox
IUPAC_name = "N"- [4-(1-hydroxy-2-isopropylamino-
ethyl)-phenyl] -methanesulfonamide


CAS_number = 3930-20-9
ATC_prefix=C07
ATC_suffix=AA07
PubChem=5253
DrugBank=
C=12 | H=20 | N=2 | O=3 | S=1
molecular_weight = 272.3624 g/mol
bioavailability = >95%
metabolism = Not metabolised
elimination_half-life = 12 hours
excretion = Renal
Lactic (In lactating females)
pregnancy_AU =
pregnancy_US = B
pregnancy_category =
legal_status = Rx-only
routes_of_administration = oral

Sotalol (trade names Betapace and Betapace AF, Berlex Laboratories, Sotalex and Sotacor, Bristol-Myers Squibb) is a drug used in individuals with rhythm disturbances (cardiac arrhythmias) of the heart, and to treat hypertension in some individuals.

Pharmacology

It falls into the class III antiarrhythmic agents because it inhibits the potassium ion channels in the heart. It is also a beta blocker because of its action on the β-adrenergic receptors in the heart.cite journal |author=Kulmatycki KM, Abouchehade K, Sattari S, Jamali F |title=Drug-disease interactions: reduced beta-adrenergic and potassium channel antagonist activities of sotalol in the presence of acute and chronic inflammatory conditions in the rat |journal=Br. J. Pharmacol. |volume=133 |issue=2 |pages=286–94 |year=2001 |month=May |pmid=11350865 |pmc=1572777 |doi=10.1038/sj.bjp.0704067 |url=http://dx.doi.org/10.1038/sj.bjp.0704067]

By blocking the potassium channels, sotalol prolongs repolarization, therefore lengthening the QT interval and decreasing automaticity.

It also slows atrioventricular (AV) nodal conduction (beta-blocking effect).

Sotalol is a racemic mix of D and L enantiomers. The L isomer is a beta blocker.

Sotalol is not selected for its beta-blocking ability, but rather for its Class III (potassium blocking) properties.

Indications

Sotalol is used to treat ventricular tachycardiascite journal |author=Boriani G, Lubinski A, Capucci A, "et al" |title=A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease |journal=Eur. Heart J. |volume=22 |issue=23 |pages=2180–91 |year=2001 |month=December |pmid=11913480 |doi= |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=11913480] as well as atrial fibrillation. [PMID 15872201] Betapace AF is specifically labeled for atrial fibrillation.

Some evidence suggests that sotalol should be avoided in the setting of decreased ejection fraction due to heart attack. [cite journal | author = Waldo A, Camm A, deRuyter H, Friedman P, MacNeil D, Pauls J, Pitt B, Pratt C, Schwartz P, Veltri E | title = Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol | journal = Lancet | volume = 348 | issue = 9019 | pages = 7–12 | year = 1996 | pmid = 8691967 | doi = 10.1016/S0140-6736(96)02149-6]

It has also been suggested that it be used in the prevention of atrial fibrillation.cite journal |author=Patel A, Dunning J |title=Is Sotalol more effective than standard beta-blockers for the prophylaxis of atrial fibrillation during cardiac surgery |journal=Interact Cardiovasc Thorac Surg |volume=4 |issue=2 |pages=147–50 |year=2005 |month=April |pmid=17670378 |doi=10.1510/icvts.2004.102152 |url=http://icvts.ctsnetjournals.org/cgi/pmidlookup?view=long&pmid=17670378]

References

ee also

*Antiarrhythmic agents
*Beta blocker