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Intentional or accidental overdosage with sotalol has resulted in death.
Symptoms And Treatment Of Overdosage
The most common signs to be expected are bradycardia, congestive heart failure, hypotension, bronchospasm and hypoglycemia. In cases of massive intentional overdosage (2–16 grams) of sotalol the following clinical findings were seen: hypotension, bradycardia, cardiac asystole, prolongation of QT interval, Torsade de Pointes, ventricular tachycardia, and premature ventricular complexes. If overdosage occurs, therapy with sotalol should be discontinued and the patient observed closely. Because of the lack of protein binding, hemodialysis is useful for reducing sotalol plasma concentrations. Patients should be carefully observed until QT intervals are normalized and the heart rate returns to levels > 50 bpm.
The occurrence of hypotension following an overdose may be associated with an initial slow drug elimination phase (half-life of 30 hours) thought to be due to a temporary reduction of renal function caused by the hypotension. In addition, if required, the following therapeutic measures are suggested:
Heart Block: (second and third degree) transvenous cardiac pacemaker.
Hypotension: (depending on associated factors) epinephrine rather than isoproterenol or norepinephrine may be useful.
Bronchospasm: Aminophylline or aerosol beta-2-receptor stimulant. Higher than normal doses of beta-2 receptor stimulants may be required.
Betapace/Betapace AF is contraindicated in patients with:
- Sinus bradycardia, sick sinus syndrome, second and third degree AV block, unless a functioning pacemaker is present
- Congenital or acquired long QT syndromes
- Cardiogenic shock or decompensated heart failure
- Serum potassium < 4 mEq/L
- Bronchial asthma or related bronchospastic conditions
- Hypersensitivity to sotalol
For the treatment of AFIB/AFL, Betapace/Betapace AF is also contraindicated in patients with:
- Baseline QT interval > 450 ms
- Creatinine clearance < 40 mL/min
Last reviewed on RxList: 5/23/2016
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