sotalol (Rx)

Brand and Other Names:Betapace, Betapace AF, more...Sorine, Sotylize
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet (Betapace, Betapace AF, Sorine, generic)

  • 80mg
  • 120mg
  • 160mg

oral solution

  • 5mg/mL (Sotylize)

injectable solution

  • 15mg/mL

Arrhythmias

Indications

  • Indicated for treatment of life-threatening ventricular tachycardia; antiarrhythmic drugs may not enhance survival in patients with ventricular arrhythmias
  • Indicated for maintenance of normal sinus rhythm in patient with highly symptomatic atrial fibrillation/flutter (AFIB/AFL) who are currently in sinus rhythm

Oral

  • Life-threatening ventricular arrhythmias
    • 80 mg PO BID; may increase by increments of 80 mg/day q3Days if QTc <500 msec
    • Monitor until steady state levels achieved; therapeutic dose usually obtained at total daily dose of 160-320 mg/day divided BID/TID
    • Doses of 480-640 mg/day have been utilized with refractory life-threatening arrhythmias
  • Atrial fibrillation/flutter
    • 80 mg PO BID; may increase by increments of 80 mg/day q3Days if QTc <500 msec
    • Monitor until steady state levels achieved; typical dose is 120 mg BID
    • Initiation of sotalol in patients with creatinine clearance <40 mL/min or QTc >450 msec is contraindicated

Use IV for substitution of PO

  • To match the exposure to oral sotalol, use the same dosing frequency with IV administration and infuse the adjusted dose over 5 hr
  • 80 mg PO: Substitute 75 mg IV
  • 120 mg PO: Substitute 112.5 mg IV
  • 160 mg PO: Substitute 150 mg IV

Use for IV loading dose

  • Infuse loading dose over 1 hr
  • IV sotalol initiation from 0 mg to 80 mg
    • CrCl >90 mL/min: 60 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 60-90 mL/min: 82.5 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 30-60 mL/min: 75 mg IV; wait at least 6 hr for first PO dose (24 hr PO dose interval)
    • CrCl 10-30 mL/min: 75 mg IV; wait at least 12 hr for first PO dose (48 hr PO dose interval)
    • If the QTc interval prolongs to >500 ms or increases 20% from baseline when initiating for an oral dose of 80 mg, discontinue drug
  • IV sotalol initiation 0 to 120 mg
    • CrCl >90 mL/min: 90 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 60-90 mL/min: 125 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 30-60 mL/min: 112.5 mg IV; wait at least 6 hr for first PO dose (24 hr PO dose interval)
    • CrCl 10-30 mL/min: 112.5 mg IV; wait at least 12 hr for first PO dose (48 hr PO dose interval)
  • Reinitiating at lower dose from 120-mg to 80-mg
    • If the QTc interval prolongs to >500 ms or increases 20% from baseline when initiating for an oral dose of 120-mg, discontinued drug and consider a lower dose
    • CrCL ≥60 mL/min: Wait at least 1 day to reinitiate
    • CrCL ≥30 to <60 mL/min: Wait at least 3 days to reinitiate
    • CrCL ≥10 to <30 mL/min: Wait at least 7 days to reinitiate
  • IV sotalol escalation 80 to 120 mg
    • CrCl >90 mL/min: 75 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 60-90 mL/min: 82.5 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 30-60 mL/min: 82.5 mg IV; wait at least 6 hr for first PO dose (24 hr PO dose interval)
    • CrCl 10-30 mL/min: 82.5 mg IV; wait at least 12 hr for first PO dose (48 hr PO dose interval)
  • IV sotalol escalation 120 to 160 mg
    • CrCl >90 mL/min: 90 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 60-90 mL/min: 105 mg IV; wait at least 4 hr for first PO dose (12 hr PO dose interval)
    • CrCl 30-60 mL/min: 105 mg IV; wait at least 6 hr for first PO dose (24 hr PO dose interval)
    • CrCl 10-30 mL/min: 105 mg IV; wait at least 12 hr for first PO dose (48 hr PO dose interval)

Dosing Modifications

Renal impairment

  • Ventricular arrhythmia (PO)
    • CrCl >60 mL/min: Give q12hr
    • CrCl 30-59 mL/min: Give q24hr
    • CrCl 10-29 mL/min: Give q36-48hr
    • CrCl <10 mL/min: Individualize dose
  • Atrial fibrillation/flutter (PO)
    • CrCl >60 mL/min: Give q12hr
    • CrCl 40-59 mL/min: Give q24hr
    • CrCl <40 mL/min: Contraindicated

Dosing Considerations

Monitoring before initiating or re-initiating

  • Perform baseline ECG to determine QT interval and measure and normalize serum potassium and magnesium levels before initiating therapy
  • Measure serum creatinine and calculate estimated CrCl to establish appropriate dosing interval (if CrCl ≤60 mL/min dosing interval adjustment necessary)
  • Continue ECG monitoring with each uptitration in dose, until steady state reached
  • Determine QTc 2-4 hr after every dose; proarrhythmic event may occur after initiation of therapy and with each upward dosage adjustment

Limitations of use

  • AFIB/AFL: Because therapy with sotalol can cause life-threatening ventricular arrhythmias, reserve use for patients in whom AFIB/AFL is highly symptomatic; patients with paroxysmal AFIB that is easily reversed (by Valsalva maneuver, for example) should usually not be treated

Dosage Forms & Strengths

tablet (Betapace, betapace AF, Sorine, generic)

  • 80mg
  • 120mg
  • 160mg

oral solution

  • 5mg/mL (Sotylize)

injectable solution

  • 15mg/mL

Arrhythmias

Indications

  • Indicated for treatment of life-threatening ventricular tachycardia; antiarrhythmic drugs may not enhance survival in patients with ventricular arrhythmias
  • Indicated for maintenance of normal sinus rhythm in patient with highly symptomatic atrial fibrillation/flutter (AFIB/AFL) who are currently in sinus rhythm

2 years or older

  • Normal renal function: 30 mg/m2 PO TID initially (90 mg/m2 total daily dose) is approximately equivalent to initial 160 mg total daily dose for adults  
  • Subsequent titration to maximum 60 mg/m2 TID (approximately equivalent to the 320 mg total daily dose for adults) can then occur
  • Guide titration by clinical response, heart rate and QTc, with increased dosing preferably carried out in-hospital
  • Allow at least 36 hr between dose increments to attain steady-state plasma concentrations of drug in patients with age-adjusted normal renal function

<2 years

  • Pediatric dosage should be reduced by a factor that depends heavily upon age
  • Use graph in prescribing information where age in months is plotted on a logarithmic scale; see manufacturer's package insert for details
  • Examples
    • Child aged 20 months: Dosing suggested for children with normal renal function aged ≥2, which is about 30 mg should be multiplied by about 0.97, which is the age factor (30 X 0.97) for a dose of 29.1 mg/m2
    • Child aged 1 week: Initial starting dose (30 mg) should be multiplied by age factor 0.3; the starting dose would be (30 X 0.3) for a dose of 9 mg/m2
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Interactions

Interaction Checker

and sotalol

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (48)

            • amitriptyline

              amitriptyline and sotalol both increase QTc interval. Contraindicated.

            • amoxapine

              amoxapine and sotalol both increase QTc interval. Contraindicated.

            • artemether/lumefantrine

              artemether/lumefantrine and sotalol both increase QTc interval. Contraindicated.

            • chlorpromazine

              chlorpromazine and sotalol both increase QTc interval. Contraindicated.

            • clomipramine

              clomipramine and sotalol both increase QTc interval. Contraindicated.

            • desipramine

              desipramine and sotalol both increase QTc interval. Contraindicated.

            • disopyramide

              disopyramide and sotalol both increase QTc interval. Contraindicated.

            • dofetilide

              dofetilide and sotalol both increase QTc interval. Contraindicated.

              sotalol, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.

            • doxepin

              doxepin and sotalol both increase QTc interval. Contraindicated.

            • dronedarone

              dronedarone and sotalol both increase QTc interval. Contraindicated.

            • droperidol

              droperidol and sotalol both increase QTc interval. Contraindicated.

            • epinephrine

              epinephrine and sotalol both increase QTc interval. Contraindicated.

            • epinephrine racemic

              epinephrine racemic and sotalol both increase QTc interval. Contraindicated.

            • erythromycin base

              erythromycin base and sotalol both increase QTc interval. Contraindicated.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate and sotalol both increase QTc interval. Contraindicated.

            • erythromycin lactobionate

              erythromycin lactobionate and sotalol both increase QTc interval. Contraindicated.

            • erythromycin stearate

              erythromycin stearate and sotalol both increase QTc interval. Contraindicated.

            • fingolimod

              fingolimod increases effects of sotalol by pharmacodynamic synergism. Contraindicated. Due to increased risk of bradycardia, AV block, and torsade de pointes, concomitant use is contraindicated.

              fingolimod and sotalol both increase QTc interval. Contraindicated.

            • fluphenazine

              fluphenazine and sotalol both increase QTc interval. Contraindicated.

            • goserelin

              goserelin increases toxicity of sotalol by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • haloperidol

              haloperidol and sotalol both increase QTc interval. Contraindicated.

            • ibutilide

              ibutilide and sotalol both increase QTc interval. Contraindicated.

            • imipramine

              imipramine and sotalol both increase QTc interval. Contraindicated.

            • indapamide

              indapamide and sotalol both increase QTc interval. Contraindicated.

            • ketoconazole

              ketoconazole and sotalol both increase QTc interval. Contraindicated.

            • leuprolide

              leuprolide increases toxicity of sotalol by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • lofepramine

              lofepramine and sotalol both increase QTc interval. Contraindicated.

            • lumefantrine

              lumefantrine and sotalol both increase QTc interval. Contraindicated.

            • maprotiline

              maprotiline and sotalol both increase QTc interval. Contraindicated.

            • moxifloxacin

              moxifloxacin and sotalol both increase QTc interval. Contraindicated.

            • nilotinib

              nilotinib and sotalol both increase QTc interval. Contraindicated.

            • nortriptyline

              nortriptyline and sotalol both increase QTc interval. Contraindicated.

            • octreotide

              octreotide and sotalol both increase QTc interval. Contraindicated.

            • octreotide (Antidote)

              octreotide (Antidote) and sotalol both increase QTc interval. Contraindicated.

            • pentamidine

              pentamidine and sotalol both increase QTc interval. Contraindicated.

            • perphenazine

              perphenazine and sotalol both increase QTc interval. Contraindicated.

            • pimozide

              pimozide and sotalol both increase QTc interval. Contraindicated.

            • procainamide

              procainamide and sotalol both increase QTc interval. Contraindicated.

            • prochlorperazine

              prochlorperazine and sotalol both increase QTc interval. Contraindicated.

            • promazine

              promazine and sotalol both increase QTc interval. Contraindicated.

            • promethazine

              promethazine and sotalol both increase QTc interval. Contraindicated.

            • protriptyline

              protriptyline and sotalol both increase QTc interval. Contraindicated.

            • quinidine

              quinidine and sotalol both increase QTc interval. Contraindicated.

            • thioridazine

              thioridazine and sotalol both increase QTc interval. Contraindicated.

            • trazodone

              trazodone and sotalol both increase QTc interval. Contraindicated.

            • trifluoperazine

              trifluoperazine and sotalol both increase QTc interval. Contraindicated.

            • trimipramine

              trimipramine and sotalol both increase QTc interval. Contraindicated.

            • ziprasidone

              sotalol and ziprasidone both increase QTc interval. Contraindicated.

            Serious - Use Alternative (88)

            • acebutolol

              acebutolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • alfuzosin

              alfuzosin and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • amiodarone

              amiodarone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • apomorphine

              apomorphine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • aripiprazole

              aripiprazole and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • arsenic trioxide

              arsenic trioxide and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • atenolol

              atenolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • atomoxetine

              atomoxetine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • betaxolol

              betaxolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • bisoprolol

              bisoprolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • carvedilol

              carvedilol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • celiprolol

              celiprolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • ceritinib

              ceritinib and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • clonidine

              clonidine, sotalol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • clozapine

              clozapine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • dasatinib

              dasatinib and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • degarelix

              degarelix and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • desflurane

              desflurane and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • digoxin

              digoxin, sotalol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • diltiazem

              diltiazem, sotalol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • dolasetron

              dolasetron and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • donepezil

              donepezil and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • efavirenz

              efavirenz and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              encorafenib and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

            • entrectinib

              sotalol and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • eribulin

              eribulin and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

            • escitalopram

              escitalopram and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • esmolol

              esmolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole, sotalol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .

              fexinidazole and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

            • flecainide

              flecainide and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • fluconazole

              fluconazole and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Avoid combination if possible. Potential for increased risk of QT prolongation.

            • fluoxetine

              fluoxetine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • fluvoxamine

              fluvoxamine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • formoterol

              formoterol and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol.

              sotalol and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol.

            • foscarnet

              foscarnet and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • glasdegib

              sotalol and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • histrelin

              histrelin increases toxicity of sotalol by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxyzine

              hydroxyzine increases toxicity of sotalol by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

            • iloperidone

              iloperidone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              inotuzumab and sotalol both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • iobenguane I 131

              sotalol will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

            • ivosidenib

              ivosidenib and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

            • labetalol

              labetalol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • lapatinib

              lapatinib and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • levofloxacin

              levofloxacin and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • lofexidine

              lofexidine, sotalol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • macimorelin

              macimorelin and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • mefloquine

              mefloquine increases toxicity of sotalol by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • methadone

              methadone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • metoprolol

              metoprolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • mobocertinib

              mobocertinib and sotalol both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • nadolol

              nadolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • nebivolol

              nebivolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • ofloxacin

              ofloxacin and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • ondansetron

              ondansetron and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • paliperidone

              paliperidone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • panobinostat

              sotalol and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • paroxetine

              paroxetine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • penbutolol

              penbutolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • pimavanserin

              pimavanserin and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

            • pindolol

              pindolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • pitolisant

              sotalol and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • posaconazole

              posaconazole and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • propranolol

              propranolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • ranolazine

              ranolazine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • ribociclib

              ribociclib and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • risperidone

              risperidone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • rivastigmine

              sotalol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

            • saquinavir

              saquinavir, sotalol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of QT prolongation and cardiac arrhythmias.

            • siponimod

              siponimod, sotalol. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Because of the potential additive effects on heart rate, siponimod should generally not be initiated in patients taking QT prolonging drugs with known arrhythmogenic properties, heart rate lowering calcium channel blockers, or other drugs that may decrease heart rate. If treatment considered, obtain cardiology consult regarding switching to non-heart-rate lowering drugs or appropriate monitoring for treatment initiation.

            • sulfamethoxazole

              sulfamethoxazole and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • telavancin

              sotalol and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

            • timolol

              sotalol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • toremifene

              sotalol and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

            • trimethoprim

              sotalol and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.

            • triptorelin

              triptorelin increases toxicity of sotalol by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

            • tropisetron

              sotalol and tropisetron both increase QTc interval. Avoid or Use Alternate Drug.

            • umeclidinium bromide/vilanterol inhaled

              sotalol increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              sotalol, umeclidinium bromide/vilanterol inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

            • vandetanib

              sotalol, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vemurafenib

              vemurafenib and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

            • venlafaxine

              sotalol and venlafaxine both increase QTc interval. Avoid or Use Alternate Drug.

            • verapamil

              verapamil, sotalol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • vilanterol/fluticasone furoate inhaled

              sotalol, vilanterol/fluticasone furoate inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

              sotalol increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • voriconazole

              sotalol and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (201)

            • acebutolol

              acebutolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • aceclofenac

              sotalol and aceclofenac both increase serum potassium. Use Caution/Monitor.

              aceclofenac decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • acemetacin

              sotalol and acemetacin both increase serum potassium. Use Caution/Monitor.

              acemetacin decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • albuterol

              sotalol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              albuterol and sotalol both increase QTc interval. Use Caution/Monitor.

            • aldesleukin

              aldesleukin increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • alfuzosin

              alfuzosin and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of Alfuzosin may be enhanced.

              sotalol and alfuzosin both increase QTc interval. Use Caution/Monitor.

            • aluminum hydroxide

              aluminum hydroxide decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • amifostine

              amifostine, sotalol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

            • amiloride

              sotalol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.

            • amiodarone

              amiodarone, sotalol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.

            • amlodipine

              sotalol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • amobarbital

              amobarbital decreases levels of sotalol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • arformoterol

              sotalol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor.

              arformoterol and sotalol both increase QTc interval. Use Caution/Monitor.

            • asenapine

              asenapine and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • aspirin

              sotalol and aspirin both increase serum potassium. Use Caution/Monitor.

              aspirin decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • aspirin rectal

              sotalol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

              aspirin rectal decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              sotalol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

            • atenolol

              atenolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • avanafil

              avanafil increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • azithromycin

              azithromycin and sotalol both increase QTc interval. Modify Therapy/Monitor Closely.

            • bedaquiline

              sotalol and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • bendroflumethiazide

              sotalol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • betaxolol

              betaxolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • bismuth subsalicylate

              bismuth subsalicylate, sotalol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.

            • bisoprolol

              bisoprolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • bretylium

              sotalol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bumetanide

              sotalol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butabarbital

              butabarbital decreases levels of sotalol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • butalbital

              butalbital decreases levels of sotalol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • calcium acetate

              calcium acetate decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

            • calcium carbonate

              calcium carbonate decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • calcium chloride

              calcium chloride decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

            • calcium citrate

              calcium citrate decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

            • calcium gluconate

              calcium gluconate decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

            • candesartan

              candesartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • carbenoxolone

              sotalol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbidopa

              carbidopa increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

            • carvedilol

              carvedilol and sotalol both increase serum potassium. Use Caution/Monitor.

            • celecoxib

              sotalol and celecoxib both increase serum potassium. Use Caution/Monitor.

              celecoxib decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • celiprolol

              celiprolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • chloroquine

              chloroquine and sotalol both increase QTc interval. Use Caution/Monitor.

            • chlorothiazide

              sotalol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorthalidone

              sotalol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • choline magnesium trisalicylate

              sotalol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

              choline magnesium trisalicylate decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ciprofloxacin

              ciprofloxacin and sotalol both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • citalopram

              sotalol and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • clevidipine

              sotalol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • clonidine

              sotalol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

            • crizotinib

              crizotinib and sotalol both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • cyclopenthiazide

              sotalol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dabrafenib

              dabrafenib and sotalol both increase QTc interval. Use Caution/Monitor.

            • dasiglucagon

              sotalol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

            • desflurane

              desflurane, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • deutetrabenazine

              sotalol and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.

            • diclofenac

              sotalol and diclofenac both increase serum potassium. Use Caution/Monitor.

              diclofenac decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • diflunisal

              sotalol and diflunisal both increase serum potassium. Use Caution/Monitor.

              diflunisal decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • digoxin

              sotalol and digoxin both increase serum potassium. Use Caution/Monitor.

              sotalol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

            • diltiazem

              sotalol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • dobutamine

              sotalol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor.

            • dopexamine

              sotalol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor.

            • doxazosin

              doxazosin and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of doxozosin may be enhanced.

            • drospirenone

              sotalol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

            • ephedrine

              sotalol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • epinephrine

              sotalol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • epinephrine inhaled

              sotalol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

            • epinephrine racemic

              sotalol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor.

            • eprosartan

              eprosartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • esmolol

              esmolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • ethacrynic acid

              sotalol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ether

              sotalol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.

            • etodolac

              sotalol and etodolac both increase serum potassium. Use Caution/Monitor.

              etodolac decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • etomidate

              etomidate, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • ezogabine

              ezogabine, sotalol. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • felodipine

              sotalol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • fenbufen

              sotalol and fenbufen both increase serum potassium. Use Caution/Monitor.

            • fenoprofen

              sotalol and fenoprofen both increase serum potassium. Use Caution/Monitor.

              fenoprofen decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • flurbiprofen

              sotalol and flurbiprofen both increase serum potassium. Use Caution/Monitor.

              flurbiprofen decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • formoterol

              sotalol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • fostemsavir

              sotalol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • furosemide

              sotalol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gemtuzumab

              sotalol and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • gentamicin

              sotalol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • glucagon

              glucagon decreases toxicity of sotalol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

            • glucagon intranasal

              glucagon intranasal decreases toxicity of sotalol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

            • hawthorn

              hawthorn increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor.

            • hydralazine

              hydralazine increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • hydrochlorothiazide

              sotalol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen

              sotalol and ibuprofen both increase serum potassium. Use Caution/Monitor.

              ibuprofen decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ibuprofen IV

              ibuprofen IV decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              sotalol and ibuprofen IV both increase serum potassium. Use Caution/Monitor.

            • indacaterol, inhaled

              indacaterol, inhaled, sotalol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

              indacaterol, inhaled, sotalol. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • indapamide

              sotalol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • indomethacin

              sotalol and indomethacin both increase serum potassium. Use Caution/Monitor.

              indomethacin decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • insulin degludec

              sotalol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

            • insulin degludec/insulin aspart

              sotalol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

            • insulin inhaled

              sotalol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

            • irbesartan

              irbesartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • isoproterenol

              sotalol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

            • isradipine

              sotalol and isradipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • itraconazole

              itraconazole and sotalol both increase QTc interval. Modify Therapy/Monitor Closely.

            • ivabradine

              ivabradine, sotalol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

            • ketamine

              ketamine, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • ketoprofen

              sotalol and ketoprofen both increase serum potassium. Use Caution/Monitor.

              ketoprofen decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ketorolac

              sotalol and ketorolac both increase serum potassium. Use Caution/Monitor.

              ketorolac decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ketorolac intranasal

              sotalol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              ketorolac intranasal decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • labetalol

              labetalol and sotalol both increase serum potassium. Use Caution/Monitor.

            • lasmiditan

              sotalol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

            • lenvatinib

              sotalol and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • levalbuterol

              sotalol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • levodopa

              levodopa increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

            • lofexidine

              sotalol and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.

            • lornoxicam

              sotalol and lornoxicam both increase serum potassium. Use Caution/Monitor.

              lornoxicam decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • losartan

              losartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • meclofenamate

              meclofenamate decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              sotalol and meclofenamate both increase serum potassium. Use Caution/Monitor.

            • mefenamic acid

              sotalol and mefenamic acid both increase serum potassium. Use Caution/Monitor.

              mefenamic acid decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • mefloquine

              mefloquine increases levels of sotalol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • meloxicam

              sotalol and meloxicam both increase serum potassium. Use Caution/Monitor.

              meloxicam decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • metaproterenol

              sotalol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

            • methyclothiazide

              sotalol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • methylphenidate

              methylphenidate will decrease the level or effect of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • metolazone

              sotalol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metoprolol

              metoprolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • mifepristone

              mifepristone, sotalol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • moxisylyte

              moxisylyte and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nabumetone

              sotalol and nabumetone both increase serum potassium. Use Caution/Monitor.

              nabumetone decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • nadolol

              nadolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • naproxen

              sotalol and naproxen both increase serum potassium. Use Caution/Monitor.

              naproxen decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • nebivolol

              nebivolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • nicardipine

              sotalol and nicardipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nifedipine

              sotalol and nifedipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nisoldipine

              sotalol and nisoldipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nitroglycerin rectal

              nitroglycerin rectal, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.

            • norepinephrine

              sotalol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • olmesartan

              olmesartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • olodaterol inhaled

              sotalol, olodaterol inhaled. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor. Beta-blockers and olodaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

              sotalol and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • osilodrostat

              osilodrostat and sotalol both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and sotalol both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxaliplatin

              oxaliplatin will increase the level or effect of sotalol by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • oxaprozin

              sotalol and oxaprozin both increase serum potassium. Use Caution/Monitor.

              oxaprozin decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • oxymetazoline intranasal

              sotalol increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. When beta-2 receptors are antagonized by nonselective beta blockers, alpha1 vasoconstriction may be unopposed, thus increasing hypertensive effect. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use an alternant anesthetic in patients taking nonselective beta blockers.

            • oxymetazoline topical

              oxymetazoline topical increases and sotalol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ozanimod

              ozanimod and sotalol both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • parecoxib

              sotalol and parecoxib both increase serum potassium. Use Caution/Monitor.

              parecoxib decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • pasireotide

              sotalol and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pazopanib

              pazopanib and sotalol both increase QTc interval. Modify Therapy/Monitor Closely.

            • penbutolol

              penbutolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • pentobarbital

              pentobarbital decreases levels of sotalol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • phenobarbital

              phenobarbital decreases levels of sotalol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • phenoxybenzamine

              phenoxybenzamine and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • phentolamine

              phentolamine and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • pindolol

              pindolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • pirbuterol

              sotalol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • piroxicam

              sotalol and piroxicam both increase serum potassium. Use Caution/Monitor.

              piroxicam decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ponesimod

              ponesimod and sotalol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

              ponesimod, sotalol. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

            • potassium acid phosphate

              sotalol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

            • potassium chloride

              sotalol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

            • potassium citrate

              sotalol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.

            • prazosin

              prazosin and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of prazosin may be enhanced.

            • primidone

              primidone decreases levels of sotalol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • promazine

              promazine, sotalol. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Increased risk of ventricular arrhythmia.

            • propofol

              propofol, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • propranolol

              propranolol and sotalol both increase serum potassium. Use Caution/Monitor.

            • quetiapine

              quetiapine, sotalol. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • quinine

              sotalol and quinine both increase QTc interval. Use Caution/Monitor.

            • rilpivirine

              rilpivirine increases toxicity of sotalol by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

            • romidepsin

              romidepsin and sotalol both increase QTc interval. Modify Therapy/Monitor Closely.

            • sacubitril/valsartan

              sacubitril/valsartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • salicylates (non-asa)

              sotalol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

              salicylates (non-asa) decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • salmeterol

              sotalol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • salsalate

              sotalol and salsalate both increase serum potassium. Use Caution/Monitor.

              salsalate decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • secobarbital

              secobarbital decreases levels of sotalol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • selpercatinib

              selpercatinib and sotalol both increase QTc interval. Use Caution/Monitor.

            • sevelamer

              sevelamer decreases levels of sotalol by increasing elimination. Use Caution/Monitor.

            • sevoflurane

              sevoflurane, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • sildenafil

              sotalol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

            • silodosin

              silodosin and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Increased risk of dizziness and orthostatic hypotension when silodosin is administered concurrently with antihypertensives.

            • siponimod

              siponimod, sotalol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.

            • sodium bicarbonate

              sodium bicarbonate decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of sotalol by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of sotalol by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

            • sorafenib

              sorafenib and sotalol both increase QTc interval. Use Caution/Monitor.

            • spironolactone

              sotalol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

            • succinylcholine

              sotalol and succinylcholine both increase serum potassium. Use Caution/Monitor.

            • sulfasalazine

              sotalol and sulfasalazine both increase serum potassium. Use Caution/Monitor.

              sulfasalazine decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • sulindac

              sotalol and sulindac both increase serum potassium. Use Caution/Monitor.

              sulindac decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • tadalafil

              tadalafil increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • telmisartan

              telmisartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • terazosin

              terazosin and sotalol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Additive hypotensive effects may occur when terazosin is used in combination with sotalol.

            • terbutaline

              sotalol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor.

            • theophylline

              sotalol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.

            • timolol

              sotalol and timolol both increase serum potassium. Use Caution/Monitor.

            • tolfenamic acid

              sotalol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.

              tolfenamic acid decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • tolmetin

              sotalol and tolmetin both increase serum potassium. Use Caution/Monitor.

              tolmetin decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • tolvaptan

              sotalol and tolvaptan both increase serum potassium. Use Caution/Monitor.

            • torsemide

              sotalol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • triamterene

              sotalol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.

            • triclabendazole

              triclabendazole and sotalol both increase QTc interval. Use Caution/Monitor.

            • valsartan

              valsartan and sotalol both increase serum potassium. Use Caution/Monitor.

              sotalol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • verapamil

              sotalol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • voclosporin

              voclosporin, sotalol. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • xipamide

              xipamide increases effects of sotalol by pharmacodynamic synergism. Use Caution/Monitor.

            Minor (30)

            • adenosine

              sotalol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

            • agrimony

              agrimony increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • benazepril

              sotalol, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • brimonidine

              brimonidine increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • cevimeline

              cevimeline increases effects of sotalol by unspecified interaction mechanism. Minor/Significance Unknown.

            • cocaine

              sotalol increases effects of cocaine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.

            • cornsilk

              cornsilk increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • dihydroergotamine

              dihydroergotamine, sotalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal, sotalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

            • dipyridamole

              dipyridamole, sotalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • escitalopram

              escitalopram increases levels of sotalol by decreasing metabolism. Minor/Significance Unknown.

            • fenoldopam

              fenoldopam increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

            • forskolin

              forskolin increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • guanfacine

              sotalol, guanfacine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

            • imaging agents (gadolinium)

              sotalol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.

            • levobetaxolol

              levobetaxolol increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • lily of the valley

              sotalol, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.

            • maitake

              maitake increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • melatonin

              melatonin decreases toxicity of sotalol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

            • metipranolol ophthalmic

              metipranolol ophthalmic increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • neostigmine

              sotalol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

            • noni juice

              sotalol and noni juice both increase serum potassium. Minor/Significance Unknown.

            • octacosanol

              octacosanol increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • physostigmine

              sotalol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

            • pilocarpine

              pilocarpine increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • reishi

              reishi increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • shepherd's purse

              shepherd's purse, sotalol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

            • tizanidine

              tizanidine increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

            • treprostinil

              treprostinil increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • yohimbe

              sotalol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Dyspnea (21%)

            Dizziness (20%)

            Fatigue (20%)

            Bradycardia (16%)

            Chest pain (16%)

            Palpitation (14%)

            Weakness (13%)

            Lightheadedness (12%)

            1-10%

            Nausea/vomiting (10%)

            Edema (8%)

            Headache (8%)

            Sleep disturbances (8%)

            Abnormal ECG (7%)

            Diarrhea (7%)

            Extremity pain (7%)

            Hypotension (6%)

            Mental confusion (6%)

            Congestive heart failure (5%)

            Itching/rash (5%)

            Syncope (5%)

            Anxiety (4%)

            Depression (4%)

            Torsades de pointes or new ventricular tachycardia/fibrillation in patients with supraventricular arrhythmia (4%)

            Peripheral vascular disorders (3%)

            Impotence (2%)

            Proarrhythmic effect (1.5-2%)

            Torsades de pointes with history of sustained ventricular tachycardia (1%)

            Frequency Not Defined

            Catechol hypersensitivity after abrupt withdrawal

            Increased insulin requirement in diabetics

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            Warnings

            Black Box Warnings

            Minimize risk of drug-induced arrhythmia by initiating or uptitrating IV or PO sotalol in a facility that can provide continuous ECG monitoring and cardiac resuscitation

            Calculate CrCl before initiating sotalol therapy; adjust dosing interval based on creatinine clearance

            Sotalol has proarrhythmic effects and can cause life-threatening ventricular tachycardia associated with QT interval prolongation; do not initiate therapy if baseline QTc is >450 msec; if QT interval prolongs to ≥500 msec, dose must be reduced, duration of infusion prolonged or drug discontinued

            Contraindications

            Sinus bradycardia (<50 bpm), sick sinus syndrome or second or third degree AV block without a pacemaker

            Congenital or acquired long QT syndromes, QT interval >450 ms

            Cardiogenic shock, decompensated heart failure

            Serum potassium <4 mEq/L

            Bronchial asthma or related bronchospastic conditions

            Known hypersensitivity to sotalol

            If treating AFIB/AFL

            • Baseline QT interval >450 ms
            • CrCl <40 mL/min

            Cautions

            Significant reductions of both systolic and diastolic blood pressure may occur; monitor hemodynamics in patients with marginal cardiac compensation

            New onset or worsening heart failure may occur during initiation or uptitration of sotalol owing to its beta-blocking effects; monitor for signs and symptoms of heart failure and discontinue treatment if symptoms occur

            Patients with bronchospastic diseases (eg, chronic bronchitis, emphysema) should not receive beta-blockers; if sotalol must be used, use smallest effective dose to minimize inhibition of bronchodilation produced by endogenous or exogenous catecholamine stimulation of beta2 receptors

            May mask sign of hypoglycemia (ie, tachycardia)

            Avoid abrupt withdrawal in patients with thyroid disease, as it may exacerbate symptoms of hyperthyroidism

            While taking beta-blockers, patients with a history of anaphylactic reaction to allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic; may be unresponsive to usual epinephrine doses

            Chronically administered beta-blocking therapy should not be routinely withdrawn before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

            Abrupt discontinuation

            • Abrupt discontinuation of beta-blockers may exacerbate angina and MI may occur; when discontinuing chronically administered sotalol (particularly in patients with ischemic heart disease), gradually reduce dose over 1-2 weeks is possible
            • If angina markedly worsens or acute coronary ischemia develops, treat appropriately and consider use of alternative beta-blocker; warn patients not to interrupt therapy without their physician’s advice; because coronary artery disease is common, but maybe unrecognized, the abrupt discontinuation of sotalol may unmask latent coronary insufficiency

            Proarrhythmia

            • Can cause serious ventricular arrhythmias, primarily Torsade de Pointes (TdP) type ventricular tachycardia, a polymorphic ventricular tachycardia associated with QTc prolongation
            • QTc prolongation is directly related to sotalol serum concentration
            • Factors such as reduced creatinine clearance, gender (female) and higher dose, bradycardia, history of sustained VT/VF, atrial fibrillation with sinus node dysfunction, heart failure increase the risk of TdP
            • TdP risk can be reduced by dose adjustment according to CrCl and by ECG monitoring for excessive QTc increases
            • Correct hypokalemia or hypomagnesemia before initiating and avoid with other drugs known to prolong QT

            Bradycardia/heart block/sick sinus syndrome

            • Sinus bradycardia (HR <50 bpm) may occur
            • Contraindicated in patients with sick sinus syndrome because it may cause sinus bradycardia, sinus pauses or sinus arrest

            Drug interaction overview

            Digoxin: Proarrhythmic events were more common in sotalol treated patients also receiving digoxin

            Calcium channel blockers: Expected to have additive effects on atrioventricular conduction or ventricular function; monitor for bradycardia and hypotension

            Digitalis glycosides, diltiazem, verapamil, and beta-blockers slow atrioventricular conduction and decrease heart rate; concomitant use with negative chronotropes can increase risk of bradycardia or hypotension

            Catecholamine-depleting drugs: May produce excessive reduction of resting sympathetic nervous tone; monitor for bradycardia and hypotension

            Insulin and oral antidiabetics: Hyperglycemia may occur; adjust dose of diabetes therapies if needed

            Clonidine: Coadministration may increase risk of bradycardia; because beta-blockers may potentiate rebound hypertension sometimes observed after clonidine discontinuation, withdraw sotalol several days before the gradual withdrawal of clonidine to reduce the risk of rebound hypertension

            Antacids: Avoid oral sotalol within 2 hr of aluminum oxide- and/or magnesium hydroxide-containing antacids

            • Antiarrhythmics and other QT prolonging drugs
              • Coadministration with other drugs that prolong QT interval (eg, phenothiazines, tricyclic antidepressants, certain oral macrolides, certain quinolone antibiotics) may increase risk of life-threatening arrhythmias
              • Discontinue Class I or Class III antiarrhythmic agents for at least three half-lives prior to dosing with sotalol; Class Ia antiarrhythmic drugs (eg, disopyramide, quinidine, procainamide) and other Class III drugs (eg, amiodarone) are not recommended as concomitant therapy
              • Limited experience with concomitant use of Class Ib or Ic antiarrhythmics
              • Additive Class II effects anticipated with concomitant use of other beta-blocking agents
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            Pregnancy & Lactation

            Pregnancy

            Both the untreated underlying condition in pregnancy and the use of sotalol in pregnancy cause adverse outcomes to the mother and fetus/neonate

            Clinical considerations

            • Incidence of VT increases and may be more symptomatic during pregnancy
            • Most tachycardia episodes are initiated by ectopic beats and arrhythmia episodes may, therefore, increase during pregnancy
            • Breakthrough arrhythmias may also occur during pregnancy, as therapeutic treatment levels may be difficult to maintain due to the increased volume of distribution and increased drug metabolism inherent in the pregnant state
            • Fetal/neonatal adverse effects
              • Crosses placenta and is found in amniotic fluid
              • Observational studies showed growth restriction, transient fetal bradycardia, hyperbilirubinemia, hypoglycemia, uterine contractions, and possible intrauterine death with exposure during pregnancy
              • Sotalol may elicit a greater effect on QT prolongation in immature hearts than in adult hearts, and therefore, conveys an increased risk of serious fetal arrhythmia and/or possible intrauterine death
              • Monitor newborns for symptoms of beta blockade
            • Labor or delivery
              • Generally, risk of arrhythmias increases during the labor and delivery process; therefore, considering sotalol’s proarrhythmia potential, monitor patients continuously during labor and delivery

            Animal studies

            • Reproduction studies in rats, early resorptions were increased at 15 times the maximum recommended human dose (MRHD)
            • In rabbits, an increase in fetal death was observed at 2 times the MRHD administered as single dose
            • Sotalol did not reveal any teratogenic potential in rats or rabbits at 15 and 2 times the MRHD respectively

            Infertility

            • Beta blockers (including sotalol) may cause erectile dysfunction

            Lactation

            Sotalol present in human milk in high levels

            Owing to the potential of serious adverse effects in breastfed children and the high level of sotalol in breast milk, advise women not to breastfeed during treatment

            Estimated daily infant dose of sotalol received from breastmilk is 0.8-3.4 mg/kg, estimated at 22-25.5% of the maternal weight-adjusted dosage of sotalol

            The amount of the drug in breast milk is similar to the neonatal therapeutic dosage; therefore, there is potential for bradycardia and other symptoms of beta blockade such as dry mouth, skin or eyes, diarrhea or constipation in breastfed infants

            Data are not available regarding effects on milk production

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Antiarrhythmic: Class II (beta blockade) and class III (action potential prolongation) properties

            Has adrenoceptor-blocking effect and markedly prolongs action potential and repolarization

            Absorption

            Bioavailability, oral: 90-100%

            Onset: IV, 1-2 hr; 5-10 min for ongoing VT

            Peak plasma time: 2.5-4 hr (PO)

            Distribution

            Protein bound: None

            Vd: 1.2-2.4 L/kg

            Metabolism

            None

            Elimination

            Half-life: Adults, 12 hr; children, 9.5 hr; prolonged in renal impairment

            Excretion: Urine (unchanged)

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            Administration

            IV Preparation

            Vial is 150 mg/10 mL

            Dilute with 0.9% NaCl, D5W, or lactated Ringer solution to volume convenient for administration and consistent with fluid restriction

            IV Administration

            Infuse over 5 hr using volumetric infusion pump

            IV loading dose

            • Measure and normalize serum potassium and magnesium levels before initiation
            • Sotalol not recommended if baseline QTc >450 ms (JT >330 ms if QRS over 100 ms)
            • Infuse IV loading dose over 1 hr
            • Initiating PO dose after IV loading dose
              • Monitor QTc interval q15min during infusion; continue monitoring around peak plasma time (2-4 hr postdose) following the first PO dose (all patients) and second PO dose (patients with CrCl ≥60 mL/min)
              • Initiating 80-mg dose: If QTc interval prolongs to >500 ms or increases 20% from baseline when initiating, discontinue drug
              • Initiating 120-mg dose: If QTc interval prolongs to >500 ms or increases 20% from baseline when initiating, consider lower dose

            Oral Administration

            Discharge patients on sotalol therapy from inpatient setting with an adequate supply of sotalol to allow uninterrupted therapy until the patient can fill a sotalol prescription to avoid having to reinitiate drug in the hospital

            Missed dose: Take next dose at the usual time; do not double the dose or shorten dosing interval

            Storage

            Tablets: Store at 25ºC (77ºF); excursions permitted to 15-30ºC (59-86ºF)

            IV: Store at 20-25ºC (58-77ºF); excursions permitted to 15-30ºC (59-86ºF); protect from freezing and light

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Betapace AF oral
            -
            160 mg tablet
            Betapace AF oral
            -
            120 mg tablet
            Betapace AF oral
            -
            80 mg tablet
            sotalol oral
            -
            120 mg tablet
            sotalol oral
            -
            240 mg tablet
            sotalol oral
            -
            160 mg tablet
            sotalol oral
            -
            160 mg tablet
            sotalol oral
            -
            120 mg tablet
            sotalol oral
            -
            80 mg tablet
            sotalol oral
            -
            160 mg tablet
            sotalol oral
            -
            80 mg tablet
            sotalol oral
            -
            120 mg tablet
            sotalol oral
            -
            240 mg tablet
            sotalol oral
            -
            160 mg tablet
            sotalol oral
            -
            160 mg tablet
            sotalol oral
            -
            80 mg tablet
            sotalol oral
            -
            120 mg tablet
            sotalol oral
            -
            240 mg tablet
            sotalol oral
            -
            160 mg tablet
            sotalol oral
            -
            120 mg tablet
            Betapace oral
            -
            120 mg tablet
            Betapace oral
            -
            160 mg tablet
            Betapace oral
            -
            80 mg tablet
            Betapace oral
            -
            240 mg tablet
            Sotylize oral
            -
            5 mg/mL solution
            Sotylize oral
            -
            5 mg/mL solution
            Sorine oral
            -
            240 mg tablet
            Sorine oral
            -
            160 mg tablet
            Sorine oral
            -
            120 mg tablet
            Sorine oral
            -
            80 mg tablet
            Sotalol AF oral
            -
            80 mg tablet
            Sotalol AF oral
            -
            120 mg tablet
            Sotalol AF oral
            -
            160 mg tablet
            Sotalol AF oral
            -
            160 mg tablet
            Sotalol AF oral
            -
            120 mg tablet
            Sotalol AF oral
            -
            80 mg tablet
            Sotalol AF oral
            -
            160 mg tablet
            Sotalol AF oral
            -
            120 mg tablet
            Sotalol AF oral
            -
            80 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            sotalol oral

            SOTALOL - ORAL

            (SO-tuh-lol)

            COMMON BRAND NAME(S): Betapace, Betapace AF

            WARNING: Sotalol should be used only in certain patients. Before taking sotalol, discuss the risks and benefits of treatment with your doctor. Although sotalol is effective for treating certain types of fast/irregular heartbeats, it can rarely cause a new serious abnormal heart rhythm (QT prolongation in the EKG). This problem can lead to a new type of abnormal (possibly fatal) heartbeat (torsade de pointes). If this new serious heart rhythm occurs, it is usually when sotalol treatment is first started or when the dose is increased. To reduce the risk of this side effect, you should begin sotalol treatment in a hospital so your doctor can monitor your heart rhythm for several days and treat the problems if they occur. Patients usually start with a low dose of sotalol. Your doctor will then slowly increase your dose depending on how you respond to the medication and how well your kidneys work. If you respond well to this medication, during this time in the hospital your doctor can determine the right dose of sotalol for you.Some sotalol products are used to treat certain types of fast/irregular heartbeats (atrial fibrillation/flutter). These products come with additional written information from the manufacturer for patients with atrial fibrillation/flutter. If you have these conditions, read the provided information carefully. Do not switch brands of sotalol without checking with your doctor.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when you suddenly stop this drug. Some people who have suddenly stopped taking similar drugs have had chest pain, heart attack, and irregular heartbeat. If your doctor decides you should no longer use this drug, your doctor may direct you to gradually decrease your dose over 1 to 2 weeks.When gradually stopping this medication, it is recommended that you temporarily limit physical activity to decrease strain on the heart. Seek immediate medical attention if you develop: chest pain/tightness/pressure, chest pain spreading to the jaw/neck/arm, unusual sweating, trouble breathing, fast/irregular heartbeat.

            USES: This medication is used to treat a serious (possibly life-threatening) type of fast heartbeat called sustained ventricular tachycardia. It is also used to treat certain fast/irregular heartbeats (atrial fibrillation/flutter) in patients with severe symptoms such as weakness and shortness of breath. Sotalol helps to lessen these symptoms. It slows the heart rate and helps the heart to beat more normally and regularly. This medication is both a beta blocker and an anti-arrhythmic.

            HOW TO USE: See also Warning section.Read the Patient Information Leaflet if available from your pharmacist before you start using sotalol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually 1 to 3 to times a day. You may take it with or without food, but it is important to choose one way and take it the same way with each dose.If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.Dosage is based on your medical condition and response to treatment. In children, dosage is also based on age and body size.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.If you use antacids containing aluminum or magnesium, do not take them at the same time as sotalol. These antacids can bind to sotalol and decrease its absorption and effectiveness. Separate doses of these antacids and sotalol by at least 2 hours to reduce this interaction.Do not take more of this drug than prescribed because you may increase your risk of side effects, including a new serious abnormal heartbeat. Do not take less of this medication or skip doses unless directed by your doctor. Your fast/irregular heartbeat is more likely to return if you do not take sotalol properly. Also, do not run out of this medication. Order your refills several days early to avoid running out of pills.Tell your doctor if your condition does not improve or if it worsens.

            SIDE EFFECTS: See also Warning section.Tiredness, slow heartbeat, and dizziness may occur. Less common side effects include headache, diarrhea, and decreased sexual ability. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: new or worsening symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, sudden change in heartbeat (unusually faster/slower/more irregular), chest/jaw/left arm pain.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: See also Warning section.Before taking sotalol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain heart rhythm problems (such as a slow heartbeat, sick sinus syndrome, second- or third-degree atrioventricular block unless you have a heart pacemaker), kidney problems, heart failure, breathing problems (such as asthma, chronic bronchitis, emphysema), very recent heart attack (within 2 weeks), overactive thyroid disease (hyperthyroidism), serious allergic reactions needing treatment with epinephrine.Sotalol may cause a condition that affects the heart rhythm (QT prolongation in the EKG). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using sotalol, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (QT prolongation in the EKG, history of torsade de pointes), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills"), if you are unable to eat or drink fluids as you normally would, or if you have conditions such as severe/prolonged sweating, diarrhea, or vomiting. Talk to your doctor about using sotalol safely.If you have diabetes, this product may mask the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness and sweating, are unaffected by this drug. This product may also make it harder to control your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Children may be at greater risk for low blood sugar (hypoglycemia), especially if they are vomiting or not eating regularly. To help prevent low blood sugar, feed children on a regular schedule. If your child cannot eat regularly, is vomiting, or has symptoms of low blood sugar (such as sweating, seizures), stop this medication and tell the doctor right away.Before having surgery, tell your doctor or dentist that you are taking this medication.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Older adults may be more sensitive to the side effects of this drug, especially dizziness, tiredness, and QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor.This medication passes into breast milk and may have undesirable effects on a nursing infant. Discuss the risks and benefits with your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use and Precautions sections.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: fingolimod.Many drugs besides sotalol may affect the heart rhythm (QT prolongation in the EKG), including amiodarone, disopyramide, dofetilide, pimozide, procainamide, quinidine, macrolide antibiotics (such as clarithromycin, erythromycin), among others.Some products have ingredients that could raise your heart rate. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).This medication may interfere with certain medical/laboratory tests, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting, unusually slower/faster/more irregular heartbeat, shortness of breath.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as EKG, kidney function tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.