Pregnancy Risk Category B
How supplied
Tablets: 80 mg, 120 mg, 160 mg, 240 mg
Action
A nonselective beta blocker that depresses sinus heart rate, slows AV conduction, decreases cardiac output, and lowers systolic and diastolic blood pressure.
Indications & dosage
Documented, life-threatening ventricular arrhythmias--
Adults: initially, 80 mg P.O. b.i.d. Dosage is increased q 2 to 3 days as needed and tolerated; most patients respond to daily dose of 160 to 320 mg. A few patients with refractory arrhythmias have received as much as 640 mg daily.
Adjust-a-dose: For patients with renal failure, if creatinine clearance is above 60 ml/minute, no adjustment in dosage interval is needed. If creatinine clearance is 30 to 60 ml/minute, dosage interval is increased to q 24 hours; if clearance is between 10 and 30 ml/minute, q 36 to 48 hours; and if it's below 10 ml/minute, dosage must be individualized.
Adverse reactions
CNS: asthenia, headache, dizziness, weakness, fatigue, sleep problems, light-headedness.
CV: bradycardia, arrhythmias, heart failure, AV block, proarrhythmic events, including polymorphic ventricular tachycardia, PVC, ventricular fibrillation, edema, palpitations, chest pain, ECG abnormalities, hypotension.
GI: nausea, vomiting, diarrhea, dyspepsia.
Hepatic: increased liver enzyme levels.
Metabolic: hyperglycemia
Respiratory: dyspnea, bronchospasm.
Interactions
Drug-drug. Antiarrhythmics: additive effects. Avoid concomitant use.
Antihypertensives, catecholamine-depleting drugs (such as guanethidine,
reserpine): enhanced hypotensive effects. Monitor closely.
Calcium channel blockers: enhanced myocardial depression. Avoid concomitant use.
Clonidine: beta blockers may enhance rebound effect after withdrawal of clonidine. Discontinue sotalol several days before withdrawing clonidine.
General anesthetics: may cause additional myocardial depression. Monitor closely.
Insulin, oral antidiabetics: may cause hyperglycemia. Adjust dosage. May mask symptoms of hypoglycemia.
Drug-food. Any food: decreased absorption by 20%. Give drug on empty stomach.
Effects on diagnostic tests
Drug may cause a false-positive catecholamine level.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with severe sinus node dysfunction, sinus bradycardia, second- and third-degree AV block in the absence of an artificial pacemaker, congenital or acquired long QT syndrome, cardiogenic shock, uncontrolled heart failure, and bronchial asthma.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING