Sotalol

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Sotalol (brand name Betapace) — Antiarrhythmic; Class III antiarrhythmic with beta-blocking activity.

Identification

• Therapeutic class: Antiarrhythmic.
• Pharmacologic class: Class III antiarrhythmic with beta-blocking activity.

Pharmacology

• Mechanism of action: Combines beta blockade with potassium channel blockade to prolong repolarization.
• Onset / peak / duration: Peak 2 to 4 hours; duration about 24 hours.
• Half-life / therapeutic level: Half-life about 12 hours; no routine level.

Clinical use

• Indications: Ventricular arrhythmias, atrial fibrillation/flutter.
• Usual dose, route, frequency: 80 to 160 mg PO twice daily, titrated.
• Maximum dose / adjustments: Adjust by renal function and QT interval.

Safety

• Contraindications: Prolonged QT, severe bradycardia, heart block, asthma, severe renal impairment.
• Black box warning: Initiate and reinitiate in a facility with continuous ECG monitoring and resuscitation capability because of the risk of serious proarrhythmia (torsades de pointes).
• Interactions: Other QT-prolonging drugs, diuretics (electrolyte loss), other antiarrhythmics.
• Pregnancy / lactation: Use only if clearly needed.
• High-alert: No.

Adverse effects

• Common side effects: Bradycardia, fatigue, dizziness.
• Serious effects to report: Torsades de pointes, syncope, severe bradycardia.
• Antidote / reversal: Magnesium for torsades; supportive care.

Nursing process

• Assessment before administration: ECG with QT, electrolytes (potassium and magnesium), renal function, heart rate.
• Interventions during therapy: Hospital initiation with telemetry; correct electrolytes first.
• Monitor: QT interval, heart rate, electrolytes, renal function.
• Evaluation / expected outcome: Suppressed arrhythmia without QT prolongation.

Patient teaching

• Patient teaching: Keep all monitoring appointments; report fainting.
• Notify provider if: Fainting, palpitations, very slow heartbeat.
• Administration tips: Consistent dosing; take on an empty stomach for reliable absorption.