Important Drug Interactions for Sotalol

Patients taking the drug sotalol (BETAPACE, BETAPACE AF, SORINE, SOTYLIZE) should be aware that it has clinically important and potentially dangerous interactions with many other prescription medications.

Sotalol, which has been marketed in the U.S. for three decades, belongs to the family of medicines called beta blockers and is approved by the Food and Drug Administration for treatment of certain life-threatening types of heart-rhythm disorders, such as ventricular tachycardia.[1] It also is approved for maintaining a normal heart rhythm in patients who have had atrial fibrillation (a common heart-rhythm disorder characterized by an irregular and often rapid heart rate) or atrial flutter.

Increased risk of fatal heart-rhythm abnormalities[2],[3]

Sotalol can cause prolongation of the QT interval — a change in the electrical activity of the heart that can lead to a fatal heart-rhythm disturbance called torsades de pointes, which can cause cardiac arrest and sudden death.

Numerous oral drugs, when used concomitantly (at the same time) with sotalol, further increase the risk of QT prolongation because they also directly cause QT prolongation (see Table 1, below, for examples). Such drugs include certain medications for treating Alzheimer’s disease, bacterial infections, depression, fungal infections, heart-rhythm disorders, HIV infection, opioid-use disorder, overactive bladder, pain and psychosis, among other disorders.

For several of these drugs, the risk of QT prolongation and potentially fatal abnormal heart rhythms is so high that they should not be taken concomitantly with sotalol.

Hypokalemia (low blood potassium level) increases the risk of developing QT interval prolongation. Therefore, patients taking diuretics (water pills) that can cause hypokalemia through increased potassium excretion in the urine — such as thiazide diuretics (for example, chlorthalidone [THALITONE], hydrochlorothiazide [MICROZIDE] and metolazone [available in generic only]) and loop diuretics (for example, bumetanide [BUMEX], ethacrynic acid [EDECRIN] and furosemide [LASIX]) — need to have their potassium levels monitored before and during treatment with sotalol.

Table 1: Examples of Oral Drugs That May Increase the Risk of Fatal Heart-Rhythm Abnormalities When Used Concomitantly With Sotalol

†Brand-name combination products that contain one or more additional active ingredients not listed
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use by Worst Pills, Best Pills News

Other important drug interactions[4],[5]

Table 2, below, lists examples of other drugs that have clinically important interactions with sotalol.

Drugs that decrease heart rate

There are many drugs that can decrease the heart rate. Taking such drugs concomitantly with sotalol may result in a dangerously slow heart rate and low blood pressure, which could lead to dizziness and fainting.

Examples include other beta blockers, which — depending on the drug — are used to treat abnormal heart rhythms, angina (chest pain or pressure that often spreads to the shoulders, arms and neck and that is caused by inadequate blood flow to the heart), heart failure, hypertension (high blood pressure), heart attacks or migraine headaches; the calcium channel blockers diltiazem (CARDIZEM, CARTIA XT, TAZTIA XT, TIAZAC) and verapamil (CALAN SR, VERELAN), which are used to treat hypertension and angina; the hypertension drug clonidine (CATAPRES-TTS, KAPVAY, NEXICLON XR); and digoxin (LANOXIN), which is used to treat atrial fibrillation and heart failure.

Beta agonists

For patientss taking sotalol concomitantly with inhaled beta agonists used to treat asthma and chronic obstructive pulmonary disease, such as albuterol (ACCUNEB, PROAIR DIGIHALER, PROAIR HFA, PROVENTIL-HFA and others), sotalol may decrease the effectiveness of the beta agonists. As a result, higher dosages of the beta agonists may need to be taken to ensure adequate treatment.
 

Table 2: Examples of Other Drugs That Have Clinically Important Interactions With Sotalol

†Brand-name combination products that contain one or more additional active ingredients not listed
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use by Worst Pills, Best Pills News

What You Can Do

If you need treatment with sotalol, review all your other medications with your doctor to assess for potentially significant drug interactions. If you are taking a medication that interacts with sotalol, your doctor may recommend stopping or adjusting the dosage of the interacting drug or may advise you to take a different drug than sotalol for your heart problem. Be aware that other drugs not listed in this article also may have dangerous interactions with sotalol.
 

References

[1] Covis Pharma. Label: sotalol (BETAPACE, BETAPACE AF). June 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/019865s022lbl.pdf. Accessed October 31, 2022.

[2] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search terms: “sotalol hydrocholoride.” Accessed October 31, 2022.

[3] Covis Pharma. Label: sotalol (BETAPACE, BETAPACE AF). June 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/019865s022lbl.pdf. Accessed October 31, 2022.

[4] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search terms: “sotalol hydrocholoride.” Accessed October 31, 2022.

[5] Covis Pharma. Label: sotalol (BETAPACE, BETAPACE AF). June 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/019865s022lbl.pdf. Accessed October 31, 2022.