Sotalol and Asthma

Hi

Asking for a friend...

He Afib has returned, 6 months after his third and final ablation.

He was restarted on Sotalol 80 mg twice daily and is very unwell. Unable to sleep but exhausted shortness of breath and very asthmatic

I understand Flecainide can also induce asthma?

Anyone have any experience with Betapsce or Tambocor?

He has used Amiodarone in the past but had thyroid issues...

Thanks for any suggestions, very glad I found this site

[Jollies]

Hi, as goldie11 says sotalol is not recommended in uk any more. Also it would not be prescribed for someone with asthma, but rather a calcium channel blocker would like verapamil.

[Hidden in reply to Jollies]

Thank you- hopefully his Dr. will switch his Rx

[horseblister]

Hi there, I am on Diltiazem a Calcium channel blocker, because I also have asthma that is difficult to manage. Beta blockers I was told is a no no because they react badly with asthma drugs. Just had another bought of chest infection because I have not yet learned how to tell when breathlessness is A Fib or Asthma. I have had Asthma 69 years but only 3 years of AFib.

[Hidden in reply to horseblister]

Yes my partner also is never quite sure is it Asthma or Afib... hoping he improves if they switch his Rx

[Hidden]

Thank you. Hopefully his Dr. will switch his Rx...

Evidently here in Canada Sotalol is still the go to for Afib

[EngMac]

I looked into this when my cardiologist recommended it and found the following. There is lots more on the net if you search. I did not take the drug since the doctor did not recommend or tell me about any of the precautions and did not schedule any of the tests. You need to do your own research and ask questions before taking any drug. Doctors don't always consider your specific health details which you know much better. Once you bring these details to the doctors attention, the drug recommendation could change.

What I found. Some of these are entries from the HealthUnlocked site.

Bob, I agree; Sotalol is not only a beta blocker, it is a potent antiarrhythmic agent with some beta blocker qualities. Not only Sotalol but other class III antiarrhythmics have the POTENTIAL to cause problems. Depending on the baseline health of the person being prescribed the drug, other class antiarrhythmics may or may not be suitable. An example of this is that some class Ic antiarrhythmic (Flecainid or Propafenon) can lead to a decrease in the ejection fraction or due to the additional activity as a beta-adrenergic blocker can cause bradycardia and bronchospasm.

Class III Antiarrhythmic agents: Amiodarone, Bretylium, Bunatine, Dofetilde, Dronedarone, Ibutilde, Nifekalant, Sotalol, Tedisamil and Vemakalant (the list is probably not complete). Each could cause, among other things, QT prolongation or torsade de pointes which is why, I believe, they are started in a hospital setting.

There are a lot of nasty, nasty drugs out there which haven’t been ‘removed’ from the NICE list. I would assume it’s always good, no matter which antiarrhythmic (or any drug for that matter) you are being prescribed, to want a good reason as to why you are being put on it. I suppose it all comes down to this: this is something you should talk to your physician about, you should listen to the reasons why you are being prescribed this along with the pros and cons, then ask questions and talk about your concerns.

My cardiologist took me off 1.25mg Bisoprolol and put me on 2 x 40mg Sotolol. I took it for 2 months but felt auful, tired, aches, lethargic, light headed, just could not be bothered doing anything. I also had my episodes of AF increase from approx 6 weeks to 2 weeks apart! I saw my GP and told him that I wanted to come off it. He didn't want to reduce my medication back to the low dose of 1.25mg, so I am now on 2.5mg Bisoprolol. I also take a low dose of Magnesium after reading good reports on here. I feel a lot better.

I've been on 80mg 2× a day for almost two years and gained 50 lbs. My doc finally took me off but now the PVC's have started. Has anybody else gained weight on it?

Sotalol is a nasty drug and no longer used in UK for treating AF as it has too many potentially nasty side affects. I'm amazed you put up with it for so long before challenging your doctor.

Warnings

Black Box Warnings

Hospitalize patient at least 3 days while on maintenance dose in facility that provides cardiac resuscitation, continuous ECG monitoring, and estimated CrCl

Calculate CrCl before initiating sotalol therapy

Sotalol has proarrhythmic effects and can cause life-threatening ventricular tachycardia associated with QT interval prolongation; reduce dose, prolong infusion time, or discontinue use if QTc is greater than 500 msec during therapy

Do not substitute sotalol for sotalol AF, because of significant differences in labeling (ie, patient package insert, dosing administration, safety information)

Betapace AF indicated for atrial fibrillation; Betapace indicated for ventricular arrhythmias

Contraindications

Asthma, sinus bradycardia, sick sinus syndrome or 2°/3° AV block unless pacemaker in place

Prolonged QT syndromes, cardiogenic shock, uncontrolled congestive heart failure, hypersensitivity, hypokalemia (<4 mEq/L), hypomagnesemia

Betapace AF & IV: CrCl <40 mL/min

Easily reversible atrial fibrillation/flutter

QT interval >450 ms when treating for AFIB

Cautions

May worsen arrhythmias

May cause or worsen congestive heart failure

Long-term administration of beta blockers should not be routinely discontinued before major surgery; however, impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

Formulations indicated for ventricular and atrial arrhythmias are different (eg, Betapace versus Betapace AF); follow instructions as applicable

Antacids given 2 hours or less before sotalol may reduce bioavailability

Reduce or discontinue therapy if QT prolongation, bradycardia, AV block, hypotension, worsening or heart failure occur

Do not discontinue abruptly; acute exacerbation of coronary artery disease may occur upon abrupt cessation of therapy

Correct any electrolyte disturbances

May mask symptoms of hypoglycemia or worsen hyperglycemia in diabetic patients; monitor

Need EKG within one week to monitor QT interval.

Can cause ventricles to go into fibrillation and death

Need to monitor potassium and magnesium levels

No longer prescribed by the NHS

Potent anti-arrhythmic and some beta blocker properties

On WebMD:

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.

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.

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 your doctor has prescribed this medication because he or she 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 any of these unlikely but serious side effects occur: new or worsening symptoms of heart failure (such as swelling ankles/feet, severe tiredness, shortness of breath, unexplained/sudden weight gain)...

Seek immediate medical attention if any of these unlikely but serious side effects occur: 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, seek immediate medical attention 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.

[GolfMyrtleBeach in reply to EngMac]

I am no longer on Sotalol, but was told by my EP and Cardiologist the Sotalol and Sotalo AF were an identical formula??? In the 4 years I was on it ( 120mg x 2) they were interchanged by the pharmacy fairly frequently. Additionally, in the US there is no hospital stay initiation period- merely and echo to check that my Ejection Factor was high enough.