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Feuerborn ML, Dechand J, Vadlamudi RS, et al. Protocol Development and Initial Experience With Intravenous Sotalol Loading for Atrial Arrhythmias. Crit Pathw Cardiol. 2023 Mar 1;22(1):1-4. doi:10.1097/HPC.0000000000000308

Dr. Feuerborn et al present an institutional protocol and retrospective review for patients treated with IV sotalol for atrial fibrillation/flutter at the University of Utah Hospital. The streamlined protocol was successfully implemented, and their initial experience suggests feasibility, safety, and tolerability while reducing hospitalization duration. https://pubmed.ncbi.nlm.nih.gov/36812336/

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)