BETAPACE AF Rx
Generic Name and Formulations:
Sotalol HCl 80mg, 120mg, 160mg; scored tabs.
Indications for BETAPACE AF:
Maintenance of normal sinus rhythm in patients with highly symptomatic atrial fibrillation or atrial flutter who are currently in sinus rhythm.
Initiate only in appropriate clinical setting that can provide continuous ECG, creatinine clearance monitoring, and cardiac resuscitation. If QT ≤450msec and CrCl>60mL/min: initially 80mg twice daily. Renal impairment (CrCl 40–60mg/mL): initially 80mg once daily; <40mL/min: see Contraindications. See literature for dose titration and required monitoring.
Sinus bradycardia (<50bpm). Sick sinus syndrome. 2nd or 3rd degree AV block, unless paced. Baseline QT interval >450msec. Long QT syndromes. Cardiogenic shock. Uncontrolled heart failure (patients with NYHA Class IV may not tolerate beta-blockade; titrate slowly and give full support if attempting to use sotalol in these patients). Renal impairment (CrCl<40mL/min). Hypokalemia (<4mEq/L). Asthma.
Not for use in easily-reversible AFIB/AFL. Do not use for asymptomatic atrial fibrillation/flutter. Do not substitute for Betapace. Increased arrhythmia risk in females, renal impairment, excessive QTc prolongation, history of cardiomegaly or CHF, sustained ventricular tachycardia, electrolyte disturbances, or with high doses of sotalol. Reduce dose or discontinue if QT interval ≥500msec occurs. Correct electrolyte imbalances (esp. hypokalemia, hypomagnesemia) before starting sotalol. Bronchospastic disease. CHF. Left ventricular dysfunction. Diabetes. Acid-base imbalance. Avoid abrupt cessation (withdraw over 1–2 weeks if possible, monitor for angina and acute coronary insufficiency). Hyperthyroidism. Surgery. Pregnancy (Cat.B). Nursing mothers: not recommended.
Class II and III antiarrhythmic.
Class IA antiarrhythmics (eg, disopyramide, quinidine, procainamide), Class III antiarrhythmics (eg, amiodarone), or other drugs that prolong QT interval (eg, some phenothiazines, cisapride, bepridil, tricyclic antidepressants, macrolides): not recommended. Withhold Class I and III antiarrhythmics for at least 3 half-lives before starting sotalol. Caution with Class IB and IC antiarrhythmics. Additive conduction abnormalities and hypotension with digitalis, β-blockers, calcium channel blockers. Hypotension, bradycardia with reserpine, guanethidine, other catecholamine-depleting drugs. Increased rebound hypertension when withdrawing clonidine. Diuretics (monitor electrolytes). Antagonizes albuterol, other β-agonists. Monitor antidiabetic agents. May block epinephrine. Avoid within 2 hours of aluminum- or magnesium-containing antacids.
Fatigue, dizziness, bradycardia, new or exacerbated arrhythmias (eg, torsade de pointes), dyspnea, ECG abnormalities, GI or visual disturbances, headache, insomnia.
Clinical Pain Advisor Articles
- Virtual Reality May Effectively Reduce Sensory, Affective, and Cognitive Pain During Labor
- Suprazygomatic Sphenopalatine Ganglion Block May Quickly Relieve Status Migrainosus Pain
- Reducing Mortality After Overdose: Is Treatment for Opioid Use Disorder Effective?
- A Physician's Guide to Incorporating Patient Spirituality in Practice
- Low Literacy Self-Management Program for Chronic Pain May Be Effective
- Neuropathic Pain Medications
- Higher Buprenorphine Dose May Not Increase Severity of Neonatal Abstinence Syndrome
- Terms Used for Addiction May Be Associated With Explicit, Implicit Bias
- Ketamine Infusions May Be Effective for Refractory Headache
- Physical, Psychosocial Activity May Be Protective Against Development of Chronic Pain in Older Adults
- The Challenge of Compassion in Modern Healthcare Settings
- Republican Opposition to Obamacare: What's Done, What's to Come
- Lowering Default Pill Counts in EMRs May Effectively Reduce Postoperative Opioid Prescription Numbers
- Steps Taken to Increase Use of Electronic Tools in Medicine
- Daily and Retrospective Pain Measurements Comparable in Hip Osteoarthritis