Sotalol

About sotalol

Sotalol belongs to a group of medicines called beta blockers.

It's used to treat atrial fibrillation and other conditions that cause an irregular heartbeat (arrhythmia).

This medicine is only available on prescription. It comes as tablets.

Key facts

• Sotalol slows down your heart rate and makes it easier for your heart to pump blood around your body.
• It starts to work after about 4 hours, but it can take 2 to 3 days to fully take effect.
• Your first dose of sotalol may make you feel dizzy, so take it at bedtime. After that, if you do not feel dizzy, you can take it in the morning.
• You'll usually take sotalol either once a day, in the morning, or twice a day, in the morning and evening.
• The main side effects of sotalol are feeling dizzy or sick, feeling tired, having diarrhoea or a headache. These are usually mild and short-lived. You're more likely to have side effects if you're on a very high dose of sotalol.

Who can and cannot take sotalol

Sotalol can be taken by adults and children over the age of 12 years. It can also be taken by children under the age of 12 on the advice of their specialist.

It is not suitable for everyone.

To make sure it's safe for you, tell your doctor before starting to take sotalol if you have:

• ever had an allergic reaction to sotalol or any other medicine
• low blood pressure or a slow heart rate
• heart failure which is getting worse, heart disease, or you've recently had a heart attack
• any problems with your kidneys
• an overactive thyroid (hyperthyroidism) – sotalol may make it more difficult to recognise the warning signs of having too much thyroid hormone in your body (thyrotoxicosis)
• severe blood circulation problems in your limbs (such as Raynaud's phenomenon), which may make your fingers and toes tingle or turn pale or blue (this may be less noticeable if you have black or brown skin)
• metabolic acidosis – when there is too much acid in your blood
• a lung disease or severe asthma
• severe diarrhoea

How and when to take sotalol

Take sotalol exactly as your doctor has told you, and follow the instructions on the label. If you're not sure, check with your doctor or pharmacist.

You'll usually take sotalol once or twice a day.

Your doctor may advise you to take your first dose before bedtime, because it can make you feel dizzy. After the first dose, if you do not feel dizzy, you can take sotalol in the morning.

If you take sotalol twice a day, try to take it in the morning and in the evening.

Important

Take sotalol even if you feel well, as you will still be getting the benefits of the medicine.

Dosage

Sotalol tablets come in different strengths: 40mg, 80mg and 160mg.

The usual dose of sotalol is between 80mg and 320mg a day. If you get irregular heartbeats several times a day, your doctor may prescribe a higher daily dose of up to 640mg.

If you are older or have kidney problems, your doctor may give you a lower dose.

How to take it

You can take sotalol with or without food, but it's best to do the same each day.

Swallow the tablets whole with a drink of water.

If you forget to take it

If you miss a dose of sotalol, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much sotalol can slow down your heart rate and make it difficult to breathe. It can also cause dizziness and trembling.

The amount of sotalol that can lead to an overdose varies from person to person.

Contact 111 for advice now if:

Go to A&E now if:

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the sotalol packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Side effects

Like all medicines, sotalol can cause side effects in some people, but many people have no side effects or only minor ones. Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people. They're usually mild and short-lived.

Talk to your doctor or pharmacist if the side effects bother you or last more than a few days:

• headaches
• feeling tired, dizzy or weak
• cold fingers or toes
• diarrhoea, feeling or being sick (nausea or vomiting)
• stomach pain

Serious side effects

It happens rarely, but some people have serious side effects when taking sotalol.

Call 111 or call your doctor now if:

• the whites of your eyes turn yellow, your skin turns yellow although this may be less obvious on brown or black skin, or you have pale poo or dark pee – these can be signs of liver problems
• you get nosebleeds that last for more than 10 minutes, unexplained bruising, or you bruise more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)

Call 999 or go to A&E if:

Serious allergic reaction

In rare cases, sotalol may cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of sotalol. For a full list, see the leaflet inside your medicine packet.

How to cope with side effects of sotalol

What to do about:

• headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches usually go away after the first week of taking sotalol. Talk to your doctor if the headaches last longer than a week or are severe.
• feeling tired, dizzy or weak – if sotalol makes you feel dizzy or weak, stop what you're doing and sit or lie down until you feel better. Do not drive, ride a bike or use tools or machinery if you're feeling tired. Do not drink alcohol as it will make you feel worse.
• cold hands or feet – put your hands or feet under warm running water, massage them and wiggle your fingers and toes. Do not smoke or have drinks with caffeine in, as these can make your blood vessels narrower and restrict your blood flow. Smoking also makes your skin colder. Try wearing mittens (they're warmer than gloves) and warm socks. Do not wear tight watches or bracelets.
• diarrhoea, feeling or being sick – stick to simple meals and do not eat rich or spicy food. It might help to take your sotalol after you've eaten. Drink plenty of water or other fluids. If you're being sick, try small frequent sips to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor. If you take the combined contraceptive pill or progestogen-only pill, and you're being sick (vomiting) or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.
• stomach pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your tummy may also help. If you are in a lot of pain, speak to your pharmacist or doctor.

Pregnancy and breastfeeding

Sotalol and pregnancy

Sotalol can be used in pregnancy, particularly if you have problems with your heart.

However, always check with your doctor that they are happy for you to keep taking it. They may wish to review your medicine and may recommend other medicines instead.

If you do take sotalol in pregnancy then you may need extra scans to check that your baby is growing at a normal rate.

Sotalol and breastfeeding

If your doctor or health visitor says that your baby is healthy, it's OK to take sotalol while you're breastfeeding.

Sotalol can pass into breast milk in quite high amounts, but studies looking at sotalol have not shown any side effects in breastfed babies. Other beta blockers have been linked with side effects in breastfed babies.

It's important to keep taking sotalol to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, seems much paler than usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible. They may recommend a different medicine for you to take.

For more information about how sotalol can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.

Cautions with other medicines

There are some medicines that may affect the way sotalol works.

Tell your doctor if you're taking:

• medicines that can cause abnormal heart rhythms – these include some antibiotics, like clarithromycin and erythromycin, and some antidepressants, like citalopram and amitriptyline
• other medicines used to treat an irregular heartbeat, such as amiodarone
• medicines for high blood pressure, such as diltiazem or verapamil
• medicines that can lower your potassium levels – these include medicines that make you pee more, like furosemide, and some steroids, like prednisolone
• medicines for asthma or chronic obstructive pulmonary disease (COPD)
• medicines for diabetes, including metformin or insulin
• medicines for allergies, such as ephedrine, noradrenaline and adrenaline

Mixing sotalol with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with sotalol.

Common questions about sotalol

How does sotalol work? How long does sotalol take to work? How long will I take it for? Is it safe to take for a long time? What will happen if I stop taking it? Do I need to have regular blood tests if I'm taking sotalol? How does it compare with other heart medicines? Will I need to stop sotalol before surgery? Can I drink alcohol with it? Is there any food or drink I need to avoid? Will it affect my contraception? Will it affect my fertility? Will it affect my sex life? Do I need to avoid playing sports? Can I drive or ride a bike? Can lifestyle changes help my heart?