What Is Sotalol, How Does It Work, And What Are The Risks/Side Effects?

Question: I have been placed on an antiarrhythmic drug called sotalol for my heart rhythm problem. How does it work and what are the side effects?

Answer :Sotalol is a commonly used antiarrhythmic drug that has been commercially available since the mid 1980's.

It's a very unique drug that it blocks potassium channels in the heart but it also blocks adrenaline to the heart, so it's a beta blocker -- which are commonly used drugs -- in addition to being a potassium channel blocker.

It's predominately used for patients that have top chamber abnormalities called atrial fibrillation, which is the most common abnormal heart rhythm that we see, but it's also sometimes used for patients that have bottom chamber abnormalities, such as premature complexes from the bottom chamber--what we call PVCs or ventricular tachycardia.

One of the things that is nice about sotalol is that there is data to show that it is safe to use this drug if you have a damaged heart, for example if you've had a heart attack. And this makes this drug a little distinct from some other drugs that we would not use in that type of situation.

The side effects that you have to be aware of is, since it's a beta blocker and blocks the adrenaline to the heart, it can slow your heart rate, and it's a blood pressure medicine. It actually can drop your blood pressure a little bit.

So it may make you a little bit sluggish or slow – usually that's not too much of a problem. There are some cases where the drug can worsen the rhythm in the bottom chamber and it's common for patients to have to be admitted to the hospital for just a few days to safely get on this drug and once you are safely put on this drug you can be followed as an outpatient.

Long term there's no serious organ toxicities with this drug. Patients feel pretty well on this and usually the only follow-up besides a good history and physical is that sometimes your cardiologist will get an electrocardiogram just to check some intervals to make sure you're on the right drug.

Since this medicine is cleared by your kidneys, if your kidneys don't work well your dose may have to be adjusted downward.