Sotalol: peaks and troughs

I read that Sotalol has an elimination half life of 10-20 hours. On a 12 hourly dosing regime, it appears the trough levels are around half the peak levels.

Before ablation I was a mixed though primarily vagal afibber. Four years after ablation I have clear adrenergic AF every day, about 6 hours total most days. Very little between 1800 and 0600. Get out of bed then it's in and out of AF all day on trivial exertion. Not that it bothers me that much.

It seems to me I could reasonably set the alarm to 0400 to take my Sotalol 120 mgs and have the second dose at say 1200.

Is there an obvious flaw in this argument?

Obviously I could just try and see. I was hoping someone could explain the pharmacodynamics of Sotalol dosing, including varying dose intervals and amounts tailored to the symptoms of the individual patient. The science of steady state, peaks and troughs in the context of Sotalol half life is beyond me now.

Maybe ILowe and ectopic1 will call by later.

[Mike11]

Based on what you say, I'd be tempted to try taking one tablet when you first wake up normally and not bother with the second at all and see if that improves your QoL enough.

[Harboreyes63]

I have taken Solatol for 6 years. What I know about it is it is suppose to only be taken at 12 hour intervals with only a one hour leeway. It stays in your system for 48 hours. I don't know where you are located but here in the states when they change a dosage they do it in the hospital over a 3 day period. I had a successful ablation almost 3 years so they lowered the dosage to 80 mg twice a day. So far so good. It is not a drug to mess with as when I was first given it it stopped my heart and I had to have a pacemaker. I saw where you mentioned Amidadronr(sp?) now that drug is dangerous. Not given here much. However all of this class of drug are dangerous because of QT levels. Good luck

[Hidden in reply to Harboreyes63]

Thanks Harboreyes63

It's good to be reminded about potential problems with Sotalol. Because I am on 120 mgs bd and my AF burden has increased dramatically over the last 6 weeks I should perhaps be cautious about making any major changes until seeing whether another ablation or another med like propafenone is an option. Seeing EP again before too long I hope.

I am in the Uk. Good luck to you too. Thanks again.

[Hidden]

Sotalol belongs to the same category as Dufetilide, they are very effective anti-arhythmic drugs, but at the same time, very dangerous and requiere extreme caution in its use. It’s adviced not to change the dose or the frequency in which was prescribed. Any unacceptable increase in the drug’s blood level, may trigger a dangerous arrhythmia. This type of drug does not work like a pain killer, that works as you go and if you still have pain you can repeat it. Anti-arrhythmic drugs require a constant steady blood level to produce the desired effect, which is the reduction of the level of sensibility or reactivity of the heart muscle to the aberrant electrical impulses of AF. Not only that, the steady blood level is the safe level designed for you according to the rate of excretion from your kidneys. If an anti-arrhythmic is no longer working as expected, the doctor has to review the dosage and perhaps increase it. If the increase does not work, perhaps is time to add another drug to the one you take, switch to another drug or have an ablation. The AF disease is a real challenge to Medicine, because the drug that once worked, can be outgrown by the AF beast after some time. With ablations happens the same thing, the “destroyed” aberrant focus may regrow in another area. That’s why one ablation might not suffice. Even the Cox Maze ablation of the entire left atria may, after some time, face another aberrant focus in the areas that were not shielded in the initial ablation. The AF beast is very sneaky and inmune to death.

[Hidden in reply to Hidden]

Thanks tachp, wise as ever, lesson learned

Great last sentence

"The AF beast is very sneaky and immune to death " ☠️

Straight out of Edgar Allan Poe.