A Sotalol question...

I have been on 2x40mcg of Sotalol per day since I was diagnosed with paroxysmal atrial fibrillation around 6-7weeks ago. After taking this medication I found that my pulse dropped to around 58 when walking around, but sometimes as little as 48 at rest. Thinking this was perhaps too slow I rang my GP (not my regular one). She said that the target rate was 55-100, so , yes, this was rather slow. She suggested halving the dose of Sotalol so that I was taking 2x 20mcg per day. I then rang the specialist nurse who I originally saw when I had my ultrasound test, and who prescribed the Sotalol. She said to take 40mcg in the morning and 20mcg before bed (as nighttime would be the time when the heart was beating most slowly). I don’t know if it’s just me, but all this sounds rather slapdash. I am not sure which of the two pieces of advice to follow, or whether it’s wise to reduce the Sotalol to below the recommended minimum dose. Another practical problem is that it is impossible to halve the 40mcg exactly so far as I can tell - if you use a knife to cut the tablet in half, it just crumbles into pieces. Has anyone had this sort of advice before, and what do you think of the general advice? Since talking. The half dose my heart has speeded up a bit to about 60 at rest, but the beat, whilst regular, feels rather “heavy” ie noticeable.

[BobD Volunteer]

Here in UK sotalol is not recommended for AF and I doubt an arrhythmia nurse would prescribe it alone so this is not a question we can really answer. My experience of arrhythmia nurse specialists is that they are usually very well educated in terms of cardiac arrhythmias so again here in UK I would take their advice over any GP . My vested interest here is that I was patient lead on the BHF arrhythmia nurse project when it was placing these nurses across UK back in 2007.

[Dianemary]

I would definitely take the advice of the specialist nurse. I have been on Sotalol for almost two years now and at one point I did have to cut the tablets, it's worth nipping into Boots (other chemists are available) and buying a pill cutter, they're not expensive and save you wasting half a tablet each time.

[Hidden in reply to Dianemary]

I didn’t know there was such a thing as a pill cutter. Will definitely buy one.

[Cat04]

bnf.nice.org.uk/drug/sotalo...

NICE recommendations for use of Sotalol for prophylaxis of (amongst others) paroxysmal AF

[Janith]

I asked my cardiologist the exact same thing ... l am on sotalol ... same rx as you. Heart rate and blood pressure quite low. But heart goes up to 120 when exercising. He said NO ... leave it as is . I am in Europe at the moment but live in America. You should listen only to your cardiologist! Do not experiment. Do not cut pills. Your heart should not feel heavy and it should not pound! Watch very carefully what you are eating and drinking! When l get back to America, l am going to ask him if l can stop one medication ... not the sotalol. I feel as though l don’t have afib at all, but l do have it l suppose. I have had two episodes. Diagnosed two years ago.

[hock217]

Smallest dose here in USA is 80 mg. I bite in half and swallow the smaller half mornings. It is so silly.....the amount of time spent making sure which half is smaller. Duh?? Why not make a 20 mg tablet?