Sotalol
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Sotalol has dual properties: non-selective beta-blockade (class II) and potassium channel blockade that prolongs repolarization (class III). It is used for atrial fibrillation/flutter and life-threatening ventricular arrhythmias. Due to QT-prolonging effects, initiation requires in-hospital monitoring for 3 days.
Exploratory record, not a reviewed medical publication.
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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.
What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Sotalol has dual properties: non-selective beta-blockade (class II) and potassium channel blockade that prolongs repolarization (class III). NutriStack rates the supporting evidence as moderate. Common adult dosing is 80–160 mg twice daily; standard maximum 320 mg/day total (doses up to 480–640 mg/day only for refractory life-threatening ventricular arrhythmias under close supervision) (as prescribed by your physician), though a prescriber sets the actual dose. This profile indexes 10 sources.
- QT prolongation and torsades de pointes (dose-dependent, ~2–4%)
- Bradycardia
- Fatigue
- Congenital or acquired long QT syndrome5
- Baseline QTc >450 ms
The bottom line
Evidence rating moderate. Most-documented uses: effective for maintaining sinus rhythm in atrial fibrillation, dual antiarrhythmic mechanism (beta-blocker + k+ channel blocker), useful for ventricular tachycardia. 10 sources indexed (2001–2025), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
The d-isomer blocks delayed rectifier potassium channels (IKr), prolonging the action potential duration and QT interval (class III activity). The l-isomer provides non-selective beta-adrenergic blockade (class II activity). The combined effect reduces heart rate, prolongs refractoriness, and suppresses reentrant arrhythmias. Racemic mixture is used clinically.
Dosing & protocol.
Absorption is reduced by ~20% with food; take on an empty stomach or at least 2 hours before/after meals; aluminum/magnesium antacids reduce absorption
Full safety detail.
Side effects
- QT prolongation and torsades de pointes (dose-dependent, ~2–4%)
- Bradycardia
- Fatigue
- Dizziness
- Dyspnea
- Proarrhythmia
- Heart failure exacerbation
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
4- 1Dronedarone vs Sotalol Among Patients With Atrial Fibrillation: A Meta-Analysis of Retrospective Observational DatabasesPMIDSingh JP, Wieloch M, Reynolds SL et al. · JACC. Clinical electrophysiology · 2025
Singh JP, Wieloch M, Reynolds SL et al.. Dronedarone vs Sotalol Among Patients With Atrial Fibrillation: A Meta-Analysis of Retrospective Observational Databases. JACC. Clinical electrophysiology. 2025
- 2Dronedarone versus sotalol in patients with atrial fibrillation: A systematic literature review and network meta-analysisPMIDSingh JP, Blomström-Lundqvist C, Turakhia MP et al. · Clinical cardiology · 2023
Singh JP, Blomström-Lundqvist C, Turakhia MP et al.. Dronedarone versus sotalol in patients with atrial fibrillation: A systematic literature review and network meta-analysis. Clinical cardiology. 2023
- 3The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysisPMIDKerin NZ, Jacob S · The American journal of medicine · 2011
Kerin NZ, Jacob S. The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysis. The American journal of medicine. 2011
- 4Meta-analysis of the Risk of Torsades de Pointes in patients treated with intravenous racemic sotalolPMIDMarill KA, Runge T · Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2001
Marill KA, Runge T. Meta-analysis of the Risk of Torsades de Pointes in patients treated with intravenous racemic sotalol. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2001
Reviews & position papers
1- 5Efficacy and safety of antiarrhythmic therapy in dogs with naturally acquired tachyarrhythmias treated with amiodarone or sotalol: a retrospective analysis of 64 casesPMIDRomito G, Gemma N, Dondi F et al. · Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology · 2024
Romito G, Gemma N, Dondi F et al.. Efficacy and safety of antiarrhythmic therapy in dogs with naturally acquired tachyarrhythmias treated with amiodarone or sotalol: a retrospective analysis of 64 cases. Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology. 2024
Reference material
5- 6Singh BN et al. Sotalol versus amiodarone for atrial fibrillation: the Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T). Am Heart J. 2005.Source linkedPMID
- 7Amiodarone Trials Meta-Analysis Investigators. Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis. Lancet. 1997.Source linkedPMID
- 8Kukendrarajah K et al. External electrical and pharmacological cardioversion for atrial fibrillation, atrial flutter or atrial tachycardias: a network meta-analysis. Cochrane Database Syst Rev. 2024.Source linkedPMID
- 9Rizkallah DH, Refaat MM. Safety and effect on length of stay of intravenous sotalol initiation for arrhythmia management. Journal of cardiovascular electrophysiology. 2023Source linkedPMID
- 10Kiskaddon AL, Decker J. Sotalol in neonates for arrhythmias: Dosing, safety, and efficacy. Journal of cardiovascular electrophysiology. 2023Source linkedPMID
Common questions.
Quick answers about Sotalol, drawn from the data on this page.
What is Sotalol?
Sotalol has dual properties: non-selective beta-blockade (class II) and potassium channel blockade that prolongs repolarization (class III). It is used for atrial fibrillation/flutter and life-threatening ventricular arrhythmias. Due to QT-prolonging effects, initiation requires in-hospital monitoring for 3 days.
What is Sotalol used for?
Commonly cited benefits of Sotalol include: Effective for maintaining sinus rhythm in atrial fibrillation; Dual antiarrhythmic mechanism (beta-blocker + K+ channel blocker); Useful for ventricular tachycardia; Can be used in patients with some structural heart disease. NutriStack rates the overall evidence as moderate.
What is a typical dose of Sotalol?
A typical adult dose of Sotalol is 80–160 mg twice daily; standard maximum 320 mg/day total (doses up to 480–640 mg/day only for refractory life-threatening ventricular arrhythmias under close supervision) (as prescribed by your physician). The commonly recommended form is Oral tablet. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Sotalol?
Reported side effects include qt prolongation and torsades de pointes (dose-dependent, ~2–4%), bradycardia, fatigue, dizziness, dyspnea, proarrhythmia. This is educational information; check with a healthcare professional before use.
How strong is the evidence for Sotalol?
NutriStack rates this as Moderate, meaning several aligned RCTs or one large RCT plus supporting reviews. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Sotalol in NutriStack.
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