For US Healthcare Professionals

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Varela DL, Burnham TS, May H, et al. Economics and outcomes of sotalol in‐patient dosing approaches in patients with atrial fibrillation. J Cardiovasc Electrophysiol.  2022; 33:333-342.  doi:10.1111/jce.15342

In a retrospective, single-center study performed among 133 atrial fibrillation and atrial flutter patients admitted to one hospital in 2017 and 2018, Dr. Daniel Varela et al examined the cost economics of oral and IV sotalol initiation, among other variables.  Proposing a 1-day IV sotalol loading protocol, the authors projected cost savings of approximately $3803 per admission.  The publication also notes that intravenous sotalol may also avoid the underdosing that may be present with oral sotalol, while allowing for quicker and more precise selection of the optimal therapeutic dose.  Finally, additional cost savings may come from freeing up hospital beds and facilitating additional admissions. https://pubmed.ncbi.nlm.nih.gov/34953091/

Highlights of Prescribing Information

Boxed Warning, Indications, and Important Safety Information

WARNING: LIFE THREATENING PROARRHYTHMIA

Sotalol can cause life threatening ventricular tachycardia associated with QT interval prolongation. To minimize the risk of drug induced arrhythmia, initiate or uptitrate intravenous sotalol in a facility that can provide continuous electrocardiographic monitoring and cardiac resuscitation [see Dosage and Administration (2.3) and Warnings and Precautions (5.1)].
Do not initiate intravenous sotalol therapy if the baseline QTc is longer than 450 ms. If the QTc prolongs to 500 ms or greater, reduce the dose or discontinue. (2.3)