Restricted dispensing

Sotalol

BETAPACE

Open Sotalol in the interactive console ↗

Pronunciation: SOE-ta-loel

Sotalol ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Sotalol ballicule

Sotalol BETAPACE mascot mnemonic cartoon — Visual mnemonic: Sotalol mascot
**“Better pace (yourself), Soda, LOL”**
LOL hat → beta blocker
QT prolongation

What it isBeta-1 antagonist with hERG blockade; atrial fibrillation and ventricular arrhythmias.

Why this oneUnlike ordinary beta blockers, hERG blockade adds rhythm maintenance — and substantial torsades risk.

What limits itInitiate with continuous ECG monitoring; renal clearance requires dose adjustment, and abrupt withdrawal is unsafe.

Sotalol molecular structure (skeletal formula) — Molecular structure: Sotalol

FDA-approved for

ventricular arrhythmias (1992)
atrial fibrillation (2000)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Life-threatening proarrhythmia (Torsade de Pointes with QT prolongation); initiate/reinitiate in a facility with cardiac resuscitation and continuous ECG monitoring; reduce dose, lengthen interval, or discontinue if QT ≥500 msec; adjust dosing interval by creatinine clearance

FDA dosing	Population	Start	Target	Max
Ventricular arrhythmias	Adults	80 mg BID	160–320 mg/day (2–3 divided doses)	320 mg/day (up to 480–640 mg/day in refractory cases)
Recurrence of AFIB/AFL	Adults	80 mg BID	120 mg BID	—
SVT/VT	Pediatric	Dose depends on age/BSA (e.g., 30/90/210 mg/m² q8h)	—	—

Titration Increase in increments of 80 mg/day every 3 days (provided QTc <500 msec)

Renal Adjust the dosing interval based on creatinine clearance

Hepatic Undefined

Monitor QTc 2–4 hours after each dose uptitration; reduce dose or discontinue if QT ≥500 msec

Instructions

Withdraw other antiarrhythmic therapy before starting
Hospitalize for at least 3 days (or until steady state) on initiation/reinitiation with continuous ECG monitoring
Correct hypokalemia and hypomagnesemia before initiating
Do not abruptly discontinue (risk of coronary artery disease exacerbation)
If a dose is missed, take the next dose at the usual time; do not double

Available strengths

tab 80, 120, 160, 240 mg
sol 5 mg/mL
inj 15 mg/mL

Contraindications

Sinus bradycardia, sick sinus syndrome, or 2nd/3rd degree AV block (unless a functioning pacemaker is present)
Congenital or acquired long QT syndrome
Cardiogenic shock or decompensated heart failure
Serum potassium <4 mEq/L
Bronchial asthma or related bronchospastic conditions
Baseline QT interval >450 msec (for AFIB/AFL)

Cautions

QT prolongation and proarrhythmia (Torsade de Pointes)
Bradycardia / heart block / sick sinus syndrome
Hypotension
New-onset or worsening heart failure
Do not abruptly discontinue (coronary artery disease exacerbation)
May mask hypoglycemia symptoms or worsen hyperglycemia
Correct electrolyte disturbances

Adverse reactions

Fatigue
Bradycardia (<50 bpm)
Dyspnea
Proarrhythmia
Asthenia
Dizziness

Pregnancy Crosses placenta; fetal risks incl. growth restriction, bradycardia, hypoglycemia, possible intrauterine death; monitor neonate for beta-blockade

Lactation Present in human milk at high levels; do not breastfeed during treatment

Cost

Sotalol (BETAPACE)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
80 mg	tab	60 BID	$4.24	offered
120 mg	tab	60 BID	$6.61	offered
160 mg	tab	60 BID	$7.80	offered
240 mg	tab	60 BID	$12.03	offered

Generic entry2000

⚠ BOXED WARNING

Initiate with continuous ECG monitoring; QT prolongation and torsades

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger4 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades4 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityMarked QT prolongation and torsades risk require renal dosing and monitored initiation in many patients.

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Memory aids: interaction avatars

Box: minimal PK interactions

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