Sotalol
Sotalol is a non-selective beta-blocker with additional Class III antiarrhythmic properties, making it unique among antiarrhythmics. It is primarily used to treat life-threatening ventricular arrhythmias and to maintain normal heart rhythm in patients with atrial fibrillation or atrial flutter.
Sotalol is a dual-action antiarrhythmic used for dangerous heart rhythm disorders.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- C07AA07
- RxNorm
- 9947
- Generic
- Sotalol
- Class
- atc-c07
- Brands
- Sotylize, Betapace, Sorine
- Availability
- rx
- Lactation
- unknown
- Routes
- oral
- Forms
- injection, tablet, solution
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
8 groupspregnancy
first trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks; consider alternative antiarrhythmic therapy
regular fetal monitoring including ultrasound
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
second trimesteravoid if possible
continue avoidance; if therapy required, use lowest effective dose
regular fetal monitoring and growth assessments
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
third trimesteravoid if possible
avoid use near delivery; may cause neonatal bradycardia and hypotension
close fetal monitoring; assess neonatal heart rate after delivery
Use of this medication in this population requires careful consideration of risks and benefits.
lactation
breastfeedingdiscontinue breastfeeding or avoid drug
sotalol is excreted in breast milk; breastfeeding mothers should either discontinue drug or stop breastfeeding
monitor infant for signs of bradycardia and other cardiac effects
Use of this medication in this population requires careful consideration of risks and benefits.
geriatric
elderlystart with low dose and titrate slowly; consider renal function
initiate therapy at 80mg once daily; monitor renal function and ECG closely; increased sensitivity to QT prolongation
regular ECG monitoring, renal function tests, and blood pressure monitoring
Use with caution and monitor for adverse effects.
pediatric_age
children adolescentsuse with extreme caution; pediatric dosing not well established
use only in specialized pediatric cardiology settings; limited safety and efficacy data in patients under 18 years
close cardiac monitoring, frequent ECG checks, and voltage-gated potassium channel monitoring
Use with caution and monitor for adverse effects.
renal_impairment
severe renal impairmentsignificant dose reduction required; CrCl less than 10 mL/min contraindicated
for CrCl 10-50 mL/min, reduce dose by 50%; for CrCl less than 10 mL/min, avoid use; monitor serum drug levels
frequent serum drug level monitoring, renal function tests, and ECG
Use with caution and monitor for adverse effects.
hepatic_impairment
hepatic impairmentno major dose adjustment required but use with caution
minimal hepatic metabolism; however, use caution in patients with severe hepatic dysfunction
monitor ECG and liver function tests periodically
Use with caution and monitor for adverse effects.
Statistics and clinical data
Drug class
Antiarrhythmic classification based on Vaughan-Williams classification
FDA approval year
Initial FDA approval date for Sotalol
Common uses
Therapeutic indications
Mechanism of action
Pharmacodynamic properties
Treatment and prevention of life-threatening ventricular arrhythmias, including ventricular tachycardia and ventricular fibrillation; maintenance of sinus rhythm in patients with atrial fibrillation or atrial flutter.
Combines beta-adrenoreceptor blocking (Class II) effects that slow heart rate with Class III effects that prolong cardiac action potential duration, helping to stabilize irregular heart rhythms.
Must be initiated in a hospital setting with continuous ECG monitoring due to risk of serious proarrhythmias including Torsades de Pointes; contraindicated in patients with asthma, severe bradycardia, uncontrolled heart failure, or prolonged QT interval; requires regular monitoring of kidney function and electrolytes.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy