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Betapace (sotalol) belongs to a class of medications known as Class II antiarrhythmics that act on the beta-adrenoreceptors of the heart by blocking their function. These drugs are used for various medical indications which may include the following:

  • The recurrence of abnormal heart rhythms such as atrial fibrillation and atrial flutter.
  • Patients who are exhibiting problematic symptoms of atrial fibrillation or flutter but who are in a normal sinus rhythm.
  • Life-threatening ventricular arrhythmias.

When should sotalol not be used?

Individuals with a heart rate below 50 beats per minute, sick sinus syndrome, second and third-degree heart blocks (unless a functioning pacemaker is present), who are in cardiogenic shock, who have a prolonged QT interval, with uncontrolled heart failure, and with bronchial asthma should under no circumstances use sotalol. 

The reason for this is since sotalol is a beta-blocking agent, this causes these receptors on the heart to slow down the rate of the organ which also decreases the individual's blood pressure. When this happens, there's decreased blood flow throughout the body. In situations when the heart rate is irregular or fast, this is a useful medication to use as it helps to control the heart rate so that blood flow is adequate throughout the body. However, when the individual's heart and cardiovascular system is compromised, then sotalol will worsen their clinical presentation.

Reduced blood flow in the body means that there is decreased oxygen transport to the essential tissues and organs which may be detrimental to the health of the patient. Signs and symptoms that may be experienced by these people include:

  • Dizziness.
  • Fainting spells.
  • Fatigue or tiredness.
  • Chest pain.
  • Irregular heart rate with or without palpitations.
  • Shortness of breath.
  • Loss of consciousness.
  • Coma.
  • Death.

Common side effects

Other side effects that may be caused by sotalol include the following possibilities:

  • Loss of appetite
  • Abdominal bloating
  • Vomiting
  • Diarrhea
  • Heartburn
  • Abdominal pain
  • Increased sweating
  • Fever
  • Headaches
  • Insomnia
  • Muscles aches and pains
  • Coughing
  • Visual disturbances

Overdose

Overdosing on medications such as sotalol is considered a medical emergency and immediate medical intervention should be sought and initiated.

The drug should be immediately discontinued and the affected individual should be monitored and closely observed. Hemodialysis is one intervention that can be performed to help get rid of the medication that has already entered the bloodstream and the patient should then have their EKG checked to make sure that their heart rhythm has normalized.

Other therapeutic measures that can be initiated include:

  • Administering atropine in the case of asystole (flatlining) where the heart stops or if the heart rate is so low that the patient experiences the mentioned symptoms.
  • Introducing a transvenous pacemaker if the patient develops a heart block.
  • Adrenaline or noradrenaline (epinephrine or norepinephrine) for a severely low blood pressure.
  • Magnesium sulfate can be given to the patient if they have Torsades de Pointes which is an irregular heart rhythm that is associated with the possible development of ventricular fibrillation.
  • Aminophylline or beta-receptor stimulants can be administered to the patient if the sotalol has blocked the beta receptors to the point where the cells that are also present in the airways have also been affected and caused the bronchi to constrict thereby resulting in decreased airflow to the lungs.

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