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AF Association
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Sotalol Or Amiodarone?

After 3 long years of pushing for help, it has been mentioned that one of two drugs might help me ie Sotalol or Amiodrone. The latter seems to have been discussed many times on here, unfortunately, not many saying anything complimentary about it, which leaves Sotalol.

Would anyone have any experience or like to comment on "Sotalol"? Please.

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Sorry but it was removed from NICE approved drugs for AF some years ago although occasionally prescribed by some cardiologists.

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One would have thought, that having a duty beyond a (duty of care), that the medical profession would strike it off of their catalogue list. Unfortunately, it would seem that they are still happy to prescribe it.

After waiting 6 weeks for my (Ultrasound result) to get back to my surgery, I finally managed to get a call back consultation! During my conversation, the one doctor (as we can be passed from pillar to post), was under the impression that alcohol along with caffeine were culprits for Afib kicking off - on that we (naturally) agreed! However, when I mentioned general foods also very much being a cause ie pastries, quiches, sauces, basically anything with saturated fat..........he was surprised 😩.

After a lengthy conversation along with a bit of pressing from me as to where do we go from here, he then mentioned options that we are all familiar with + what do I want to do ie (possible) ablation or other medications. The medications mentioned were as per topic.

Tbh his knowledge seemed very sketchy, on that basis rather than try that above medications I have opted to go back to the Cardiologist to see what he would recommend. The crazy part is; I would have thought that it would have been natural progression for advice to have come from the Cardiologist in the first place! Is the world mad Or is it just me?

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It’s the workd, I’m afraid. My friend who has diabetes and heart failure just told me she was having so many problems with her ankles swelling that she woke up in bed and the sheets by her feet were soaked, her ankles had actually leaked. She soon went to a heart failure clinic and they found out she had been prescribed a medication for her diabetes by her primary that should never be given to someone with heart failure. The clinic doctor phoned the primary. The primary stated she didn’t know my friend had heart failure! My own chart recently had me listed as diabetic, and I’ve never had diabetes. The world is mad.

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Hi John

If you type Sotalol into the top right search box on this page and then click on what looks like a magnifying glass, it will throw up all the info ever discussed on here relating to it. Sotalol comes up for discussion on here quite a bit.

Amiodarone damaged my thyroid, as it has to others on this forum, and I would never recommend taking that. Flecainide appears to be the drug of choice right now.

Jean

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Jean thanks, I did see it. I could see that many of the posts were a year ish old, basically I was looking to see if there was anything more updated/more experiences etc. x

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Just had another look and no, they're not. You did type it in the search box? Hope other members will come forward and give you some advice. I've taken Sotalol on two different occasions, but it wasn't for me. I've heard some people get on with it really well.

Jean

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"You did type it in the search box?".

I tapped to the left hand side of the page "Sotalol" (Related Tags). All of them headline "1 year old", I did not read any further or go through them. If there is another page, I missed it.

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I think screens appear differently depending on what device you are using. I'm on a PC and right at the very top of the screen in the same line as the green Health Unlocked title and to the right is a box named Search HealthUnlocked, type Sotalol in this box and then click on the magnifying glass to the right. Not the Related Posts, they are old.

Jean

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"I think screens appear differently depending on what device you are using. I'm on a PC ".

You are right, it depends......I was working off of my tablet - a differing layout.

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I am on sotalol. It has helped me. Mine is cardiomyopathy not yet diagnosed and sustained v tach. Haven't been shocked since. Was on 80mg went to 40mg 2 times per day

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Thank you, John.

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Hi Jean.

I’ve been on Amiodarone for 6 week’s now and am concerned about side effects. Can you share your experiences of it particularly how long you were on it before they discovered you had a thyroid problem. I had my initial blood tests last week and the thyroid test can back as OK but borderline so another test in 3 months time. Everything else (renal, blood count etc), was fine. I’m wondering if 6 weeks is too soon for it to affect my thyroid and if “borderline” is simply my starting point anyway if you see what I mean. I know it doesn’t affect the thyroid in everyone but I’m concerned nonetheless.

Thanks

Ian

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Hi Ian

To tell the truth, I can't remember how long I took it for. Perhaps 6 months pre and post my first two ablations. My GP watched my thyroid function after then hoping it would go back to normal, he watched it for several years and during that time doing the slightest thing would tire me out and I blamed feeling that way on my AF. In the UK I believe the normal function level is below 5, in some countries it's below 2. Do you know the number for the level you are now, you can ring and ask receptionist to tell you if you want? It wasn't until another consultant thought he would check my thyroid function, that the problem was noticed and my doctors surgery were told I should be on thyroid medication. After taking it, all my extreme tiredness disappeared.

Jean

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Amiodarone damaged my thyroid, too (hyperthyroiditis) but it has recovered (took 8 or 9 months to normalize). On the other hand, amiodarone also controlled my AF for more than 5 years. It does have a long list of other potential side effects but it may be worth it for some people.

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I took Sotalol for 8 years without side effects. Maybe I shouldn’t have, since I have vagal AF for which betablockers may be unhelpful.

Am I right that NICE’s position on Sotalol is that it should not be used as a first choice anti arrhythmic but doesn’t rule out using it subsequently.

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See Cat04 reply further down, it should answer your question.

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Hi John

I was on Sotalol for about 15 months and it would work for a while then it wouldn’t so my dose would increase. I didn’t have any side effects until I was on the maximum dose (320mg per day) and I was fatigued and started getting pins and needles in my hands and feet. In the end even the highest dose couldn’t control things so I’m now on Amiodarone, Digoxin and Atenolol. My EP said that he won’t keep me on Amiodarone for long because of the side effects of long term use. I’m concerned about the sun sensitivity as I live in Australia and it’s now summer so I have to cover up and lather myself in 50+ sunscreen each day. Amiodarone can turn your skin blue. I generally feel better most of the day and I have more energy but I still get daily AF episodes. Prior to Sotalol I was on Verapamil and then Flecainide. Not sure how many options are left 😃 I’ve had 3 ablations (2 for SVT and 1 for Atrial Flutter and AF).

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Quite a few on here have kicked Amiodarone into the long grass due to thyroid problems. It would also seem that many of the drugs have a useful life span, before we then have to try something else, something that does not affect our quality of life.

Thank you.....John.

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Yes, it’s an ongoing challenge, that’s for sure. There are no easy answers.

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I have been on Sotalol 40 mg twice a day for one year. I seem to be doing well on it. I have always had a slow heartbeat but the Sotalol has not made it much lower. My EP said I could probably not tolerate a higher dose due to the bradycardia. I asked about flecainide, but he said when one is put on flecainide, you also have to be on a beta blocker because the flecainide can cause some faster arrhythmias on occasion. I guess that is why the Sotalol is a combination anti arrhythmic and beta blocker all in one. Hope this helps.

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That being said, my fasting glucose increased 15 points this year, from 97 to 112. Apparently the beta blocker in Sotalol is non-selective, so I am not sure what I need to do about that. I have not been diabetic but my grandfather was.

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Thank you......John.

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I was on Sotalol for years and my fasting glucose was relatively stable but when I changed to Flecainide I also started Dialtiazem - my fasting glucose has gone from 100 (5.5) to 145 (8.0) over three years so its been a double edged sword getting off Sotalol.

My Dr. is trying to see if there is a better option with a Channel Blocker.

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Do let us know what he/she along with yourself decide. It is always good to know if there are alternatives out there.

Thanks John

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She did mention Verapamil but needs to get the Cardiologist to agree that its suitable and not create other problems.

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Without wishing to sound condescending, I think that checking it out with your Cardiologist is the right thing to do. My own GP was asking me "What do you want to do"?, as opposed to passing on his knowledge/experience of what is best! Once I was aware of his mindset, I then tend to lean to the cautious side re pills Or as I am going to do......refer back to my Cardiologist. The GPs in our practice seem to have very little knowledge of our condition.

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As soon as I mentioned my blood sugar had progressed from diet control to needing Empagliflozin she asked what drugs had I started in the last three years.

Diltiazem was her first thought particularly if taking a statin as it ties it up and reduces insulin production.

I had only stopped atorvastatin (5mg) in the last six months .

I dont think you sound condescending , I have had quite a few drugs interact in a negative way so it is pleasing to have a Dr. be proactive before any complications arise ( not that she can change my heart meds without his agreement )

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Hi John. I started on Sotalol 80mg x 2 daily about a month ago after Flec gave me Atrial flutters. Sotalol seemed to be controlling my AF better than Flec although I did have incidents of palpitations/ectopics/Tachycardia on and off albeit ‘milder’ ones compared to when I was on Flec. However as this meds did not completely control my AF and the palpitations started to affect my quality of life, about 3 weeks ago, my EP suggested increasing the dose to 120mg x 2. That so far seemed to do the trick. I have had no AF this far and almost no palpitations either. Well I did have may be twice but it lasted less than 1 minute. So far I have had no bad side effects from Sotalol. Only when I first started my BP was a bit low but as my body is used to it I am OK now. I am hoping that Sotalol will be THE med for me to control the AF at least for the next couple of years before I would personally consider ablation (unless I have no choice but to do it earlier). But my EP did mention to me about the side effect which is the Prolongation of the QT and he said we will closely monitor that. Another side effect of Sotalol is Torsades de Pointes (TdP). I personally feel that as each one of us reacts differently to medications, as long as we know the risks and are aware of the side effects and are in constant communication with our EP we should generally be OK. My EP also mentioned Amiodarone as an effective drug for AF but one can’t be too long on it as like others say it is a nasty drug. I hope all will go well for you.

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I guess that it is early days yet, however the signs appear to be good. Please keep us up to speed as to how you are doing.

Thanks John

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Yes. Indeed. It has not been a month even. Keeping my fingers crossed.

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I've had a lot of success with sotolol. I was on it for 3 years until it stopped working (ie I had a-fib episodes and needed cardioversion). My cardiologist then switched me to amiodorone, which is considered the strongest anti-arrhythmic but also has more potential side effects. For me, it worked well for 4+ years, but then it started affecting my thyroid, so I had to stop. I was referred for an ablation at that point, but they wanted me to stop amiodorone for 3 months before the procedure; it apparently stays in your system quite a long time. I was put back on sotolol , and lo and behold, it worked fine; I could take that up until 2 days before the ablation.

After the ablation (9/3/18), I was kept on sotolol for another 3 months until the scar tissue had built up in the atrium. I stopped the sotolol 2 weeks ago, and so far, no irregular heartbeats! So I'm feeling pretty hopeful!

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Amiodrone gets a bad write up from many. However, I guess that the medics must rate that it has more pluses than minuses. In my own mind (unless something else crops up in the meantime), I will probably try the Solatol route, possibly Amiodrone if Solatol does not work out, followed by an Ablation if necessary.

Thanks John

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I must say that after months of AF, to convert to NSR after only a day or two of amiodarone felt akin to a miracle!

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Glad it worked for you.

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I have been on Sotalol for 13 months now (80mg twice a day) and it has been very effective at controlling my PAF. I shall be weaning off it following my ablation and carry it as a pill in pocket drug in case PAF returns. My EP is a very experienced man at the South West Cardiac centre that Mr Guy Haywood leads and I'm sure he knows about the NICE guidelines and selected the drug appropriate to my PAF .

NICE guidlines updated Nov 2018 state that sotalol is used for prophylaxis of PAF

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

NHS also give similar info

nhs.uk/medicines/sotalol/

Sotalol has good results and despite people on this forum dismissing it and trying to undermine our confidence and trust in our EP/cardiologists choice of this drug, it does seem to be a useful tool in the EPs drug box.

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Good results for you, nice to hear. I would not have thought that people are actually trying to undermine confidence /trust etc, it would be more of a personal experience/what I know information exchange. Having said that it is good to hear the positives and of course the update.

Many thanks John

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I was on Sotalol for two years before it lost its efficacy. It was a high dose 180 twice a day and it affected my QT rhythm so I had to stop it. It worked well regarding controlling the AF but I also experienced poor sleep with nightmares and a general depressive feeling. The next step was Bisoprolol but again though working well caused tiredness, poor sleep, numb feet, breathlessness, etc so on the recommendation of Finvola I badgered my Consultant to let me try Nebivolol and six months later I can say that sometimes I forget I suffer from AF!!

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I seem to have gone on the reverse route to you. I started on Bisoprolol 2.5, then to 5.0mg. It was then mentioned that I was going up to 10mg (I refused). My HB was already dropping down to 43/44, which I felt was causing more Afib. I then went onto Nebivolol 5mg, mainly to see if the being constantly cold bit would disappear......not so. However, my BP dropped into a nice range (might have been the extra 4 lbs that fell off at the same time - who knows?). The chances are that I might end up where you started off - what a lottery?

Thanks John

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I took sotolol for around eight years..it did work started on 40 mg per day.

Ended up on 80 mg twice a day. I was always tired with legs like lead.Used to walk ten steps and then stop for a rest.when the AF broke through however ,which was quite a lot extra doses would not stop it .Had to go to AE to slow my hr.Always had bisoprolol there .so asked to be put on it.That was because bad

reports on the forum about sotolol I am in the UK. ...I am now on Nebivolol.2.5 mgs for the last three months and my life is so much better.

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The Nebivolol 5mg is not stopping mine as such. The past 3 mornings I have been woken by it. I am beginning to wonder if it is a gravitational problem, as (most) of mine are night time episodes ie laying down!

Thanks John

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John6,

I took amiodrone for 4 months and solotol for 4 months. As bad as I have heard I didn’t have a problem with either one. However the solotol did a much better job of keeping my heart rate in check, the down fall was I felt much more lathargec on it. So take what you will. I was so determined not to take amiodrone because of everything I read. But after an ablation I am fortunate enough to not have to take anything. Good luck to you.

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Kahst thank you. So glad to hear that it has worked out for you. Re Amiodrone, most seem to have had a problem through long term use. Having said that ,there are good and bad experiences either way.

Thanks John.

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I was pleased to read about others having an elongated QT wave which EP says was caused by Flecanide. The elongation is mild and told will be monitored. Currently enjoying peace within my heart rhythm while on on 50mg two times daily and small dose metoprolol ( long acting kind). Keeping calm during the holiday season and minding my p’s and q’s concerning alcohol and caffeine. The other drug EP mentioned he would have me on was Sotolol

I will probably have a third ablation in 2019.

Just hanging in there so I can visit Cuba in March . Not sure about medical support there but EP said ask for cardio version

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Clarification: Pleased that there was conversation about the QT wave not that others were experiencing it like me

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Always good to know what treatment is working for others along with having the QT wave pointed out, not something that I was aware. Hope all goes well for Cuba.

Thanks John.

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I took many drugs for afib and all had side effects, the last one they put me on put me in the hospital. in the hospital I was prescribed sotalol 80 mg 2x a day. It kept my heart in sinus but made me feel sick and dizzy. I experimented and started taking 40 mgs 2x a day and with the approval of my Doctor I now take 40mgs. With the message to take 40mgs more if the heart goes afib. This has worked great for me I feel better now than I have felt in many years. I now have no side effects,

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It so easy to say if you/I are not feeling well (I'm not taking those anymore)! A clear illustration from yourself is to try another (lower - if available) dosage of the same, well done.

P.S. It amazes me as to why medics in many cases go in with dosages that are too high. I would guess that on the basis of the patients body not accepting the medicine, (because the dosage is too high), then many move onto something else. Unfortunately not enough fine tuning takes place! Something that I will always try to bear in mind. Having said, that I once refused a higher dosage (10mg Bisoprolol), as I could see it being detrimental to my wellbeing.

Thanks John.

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For me Sotalol did not work at all. The only thing it did was make me unable to function. I had an ablation and thankfully it worked! My entire life would have changed if I had to stay on that. It was depressing. I think sometimes doctors think one size fits all as far as medications go. What works with no symptoms for one, is a life changing nightmare for the next. I wish you luck.

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". I think sometimes doctors think one size fits all as far as medications go. What works with no symptoms for one, is a life changing nightmare for the next".

I agree with you totally on the above, something similar to what I have said in the past. Far too many imo are ready to reach for a Pharmaceutical catalogue, instead of doing an in depth examination of the patient. The mentality being - it worked for him....it will work for her. In doing so, they may very well cure one problem, unfortunately they can and do bring other conditions on. Glad it worked out for you.

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Staying on flecainide recently increased offered Sotalol but wasn't impressed with the information from others here. Good luck

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I sorry that you weren't impressed with information given. The people on here are generally exchanging experience along with general information that was pertinent to them, hopefully helping others. In my book; if I come away with a big more knowledge before I had asked,it equals a result. Generally there are more pluses than minuses.

Thanks John

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John I probably haven't worded my statement correctly. I meant people were saying they weren't impressed with this drug not that I wasn't impressed by what people were saying. It has now been taken off which didn't surprise me but my cardiologist ladt week talked about putting me on it and because if what people had said that's why I wasn't impressed. Probably still not clear. People on this site Bob Jeannie Flap Jack and many others are knowledgeable and supportive we are very lucky to have this support. Best wishes chris

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Not a problem. I have often been guilty of miscommunication.

Thanks John.

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Hi John6- I just stopped taking amiodarone after starting it in the hospital in late August. i was admitted because I'd become unable to breathe normally when lying down. I was told I had congestive heart failure - at the time my ejection fraction was 25%, with 65% being normal. I was discharged on September 10, and sent home with the amiodarone. I had an echo cardiogram on September 24, showing my ef had returned to 65%. I continued taking the amiodarone because I wasn't aware of the potential side effects and it was keeping my afib away. About a month later I went to my primary and asked for a thyroid test because I'd googled the side effects, saw about the thyroid, and realized my pleasantly easy weight loss could be due to the drug. I was diagnosed with hypothyroid, and told if it continued another 3 months, I should see an endocrinologist. I saw my cardio PA, who said I could stop the amio any time, and after 3 weeks can start flecainide. I just took my last amio Tuesday, and my jitteriness is already going away. I've learned there are also effects on vision and liver, and all these can be permanent. I'm hoping my brief 3-1/2 months doesn't result in permanent damage, although I keep wondering if my vision really is getting worse. Hope to see the eye doctor next week. Has your doctor suggested flecainide?

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Hi inezelsie, It would seem that Amiodarone can act pretty quickly on the wrong side of things. It is a shame that the medics don't automatically call patients back to check this recurring problem.

"Has your doctor suggested flecainide?"

I was initially taking the guidance of my GP, whilst he gave me the impression that he knew a bit about it, I came to realise that his follow up/care skills were zero, pretty much in line with his knowledge. To cut a long story short I feel that I have been very much on my own, only getting to where I am due to my own persistence. There is a general lack of communication from the hospital that I have attended (ultrasounds etc), with our surgery also being very much the same (I am doing practically all of the chasing up). At the moment I have a referral appointment back at the hospital in Feb 2019, hopefully, I will get more sense and guidance from them.

The reason I have asked the question on the forum is to glean as to what works and what does not. One thing I do not want to do is to come across as a nodding donkey when the medics suggest whatever treatment - not that I am like that anyway, as I do like to have a wee bit of knowledge of what (they) are talking about. Imo it tends to focus them, insomuch they talk (to you) - not (at) you.

At the moment Solatolol and Amiodarone have been mentioned as possible treatments from the hospital report by my GP - we shall see! Flecainide is one that I shall mention.

Thank you

John

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FWIW, I have been on Amiodarone for a total of ~10 years. I have had literally no side effects beyond having to be really careful to apply sunscreen and some issues with pre-existing hypothyroidism stemming from iodine metabolism which are under control, I so I'm really lucky, especially as amiodarone is available as a very cheap generic.

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I guess that is why the medics keep on prescribing it, it obviously works for more patients than fails them. This clearly demonstrates as to why it is so important to read the leaflet information that comes with our medication. With the info from the aforementioned along with the actual experience of those on the forum using it, I feel that a better picture emerges. Imo anyone who is on new medication and experiences things that does not feel right, should immediately report back to their Medic, instead of letting it get out of control. My thoughts are that Thyroid problems seem to be high on the list - something more than the norm to look out for.

Thank you

John

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What dosage are you on Pengie. (If you don't mind sharing). Good luck and happy Brexit.

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200 mg/day

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Hi John

I have been taking Sotalol for the past three months/ 40mg twice a day and to take on standby when I have woken up with my heart racing which is always during the night/happened only twice since taking Sotalol which is great for me.

I have AF maybe once/twice a year/hospitalised.

Previously been on Metoprolol Tartrate 50mg as a standby pill/ approx three years/ eventually they gave me scary hallucinations/I would lie awake in bed just watching the incredible images appear behind my closed eye. I was also in awe of the incredible detail/ so artistic, amazing of the hallucinations! So I'd put my light on to get rid of them, then walked around like a zombie all day, worn out.

My EP suggested an ablation but my doctor said we would try and manage AF/racing heart with Sotalol.

At last! Since taking it I sleep like a baby and my quality of life has returned after years of struggling.

I don't really or can't be bothered to read all the comments from HealthUnlocked as think I would become neurotic with worry! Plus too busy enjoying my life!

But I visit the website now and again thinking I must be sensible and keep up with the side effects of the drugs I take. So reading your comments on Sotalol and other people's comments /good/bad I will just wing it as it's working for me at present!! Just to add, I have thrown out biscuits, cakes all bad stuff... Always been a healthy eater/fish/loads veg/loads fruit/ cooked healthy food BUT addicted to sugar so cold turkey to no sugar or milk just mainly plant-based and I am nearly the same weight I was as a slim young woman! As I'm a busy person I just manage to fit in swimming three times a week and walk enjoying the stunning countryside where I live. Why hadn't I done this years ago, well because I couldn't kick the sugar, I feel so much younger than my 72yrs surely it helps. We are what we eat! Ha! Hope I've got the right saying! Yes I still crave sometimes for a bar of chocolate but my health is more important, the choice is ours. Phew! Can anyone be bothered to read my long long comment!!

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Hi Adventures, Yep I read it all😉.

My appointment is on the 22nd of this month, the responses on the forum have all been taken on board. On the back of that, I will see what they have to say before I chip in with my tenpence worth. I would guess that a lot of your improvement is down to the changes that YOU made, although Sotalol is also doing its bit . P.S. I do not even look at a chocolate bar anymore, even though there is a tupperware container full of them in the kitchen cupboard 😨......you will get there😀

Thanks John.

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Hi John

Will be interested what the result of your appointment/ to chip in your tenpence worth!! My curiosity has awakened of the side effects for Sotalol plus the length of time I am able to take it, especially if it suits?! My doctor put me on it without discussing any... suppose it's not easy for them as no-one would take any drugs if we were told... plus everyone reacts differently. Yes, I'm being sensible now foodwise and it will help, good that you can resist your tupperware of chocolate !! But I agree I personally couldn't do without Sotolol now. Good luck with your app.

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Just reading the leaflets are enough to frighten the life out of you/I. Having said that "Forewarned is Forearmed", as I would rather know, than not know potential side effects. I tend to look at it from the point of view that the things mentioned, have obviously happened to others - overall, they are generally safe....ish. Will keep you up to speed, thanks - John.

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Totally agree.

Good to share side effect experience!

Thank you for your input...

Emma

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