Sotalol and Prolonged QTc

[SpritzerAce]

Hi ! Hope you are all keeping well. This post is specifically to ask anyone who is or has been on Sotalol or any other drugs that caused PQTc and to know how you are managing the acquired prolonged QT that is caused by the medication? Would really like to know how often do you check for your QT? Don’t you develop any symptoms associated with it and how do you cope? Has anyone actually been taken off it because of the prolonged QT it caused? Anyone here experienced TdP or syncope?

FYI. The QTc interval varies from 0.35 to 0.46 seconds (350-460 milliseconds). About 95% of people have a value between 0.38 and 0.44 seconds, which is the range doctors generally consider normal. A QTc longer than 0.45 seconds (450 milliseconds) may be cause for concern in patients receiving a QT prolonging drug; and a QTc of 0.50 (500 milliseconds) or longer often indicates a high risk of arrhythmia. (Extracted from acquired LQT brochure06).

Thanks everyone.

[irene75359]

Sorry I can't help but I am sure someone on the forum will answer shortly.

[SpritzerAce in reply to irene75359]

Thank you.

[Hidden]

Sotalol for 8 years, prolonged QT never mentioned. Concurrently Sertraline. Again, not discussed. No side effects from either. QT interval normal on my hand held ECG monitor.How much of an issue is there in the absence of congenital prolonged QT?

[SpritzerAce in reply to Hidden]

Thanks. Apparently the issue is the same as congenital PQT except that the acquired one can be reversed once medication is stopped.

[Aus19]

Here is an Australian website that might be helpful (just paste it in your browser if the link isn't live):

nps.org.au/australian-presc...

This link talks about differences in QTc limits for men and women, effect of grapefruit juice, etc. You probably know this stuff already.

I was on Sotalol for several months and it did slow my heart rate, taking my QTc interval to 420 ms. The Sotalol was discontinued because it wasn't stopping my AF. My EP had no particular concerns about the effect of the Sotalol on my QTc (which wasn't monitored in any particular way). I suspect Sotalol is a drug that may be more commonly prescribed in Australia. When it's prescribed here, you just start taking it at home (it isn't first administered in hospital or anything). But that may depend on the patient's health (I'm 51, no health problems other than AF and an AF-induced stroke). I tolerated the drug with no problems but, as I said, I wasn't on it for that long.

[BobD Volunteer in reply to Aus19]

It is not on NICE list for AF here in UK.

[sugaredalmonds in reply to BobD]

I know every time sotalol is mentioned on here, we are reminded it is not on the NICE list here in the Uk, however for whatever reasons some of us on here do take it.

[BobD Volunteer in reply to sugaredalmonds]

I agree that some EPs do still prescribe but it is rare. It has been described as a very dirty drug for the reasons already mentioned. It was much more popular seven or eight years ago.

[sugaredalmonds in reply to BobD]

I dare say this is good information, however, the referred to comment, can & does at times frightened the ‘••••’ out of me for one, even though I am doing ok with it & touch wood will continue to do so.

Of course at the end of the day I always feel we are at the mercy of the pharmaceutical world & their aim undoubtedly revolves around profit.

[SpritzerAce in reply to sugaredalmonds]

Yes I know right ... apparently my QT has a prolongation because of Sotalol but my EP hasn’t risen the red flag yet. She just reduced the dose from 160mg x2 per day to 120mg x2. Not sure at what point I will be asked to stop.

[danagreen in reply to BobD]

It is now -just checked but no good at IT so cannot link it. Entry dated March 2019

[SpritzerAce in reply to Aus19]

Thanks. What are you on now to manage the AF?

[Aus19 in reply to SpritzerAce]

Flecainide 100 mg, twice daily. Plus Atenolol and Apixaban. The flecainide works to some extent: I have episodes of AF, as well as atrial flutter, but my heart rate doesn’t much exceed 130 bpm. I guess the main difference from the Sotalol is that my heart isn’t as slow now I’m on flecainide. I have headaches on the flecainide and it may well have contributed to my developing atrial flutter, but I understand it is a relatively safe option for long term use. By the way, my Sotalol dosage was 80 mg twice daily.

[SpritzerAce in reply to Aus19]

OK. Ha .. true we are all different and react differently to medication. Flec did not go well with me hence the change to Sotalol.

[sugaredalmonds]

I have been on sotalol for seven years, prolonged QT has never been mentioned to me either🤔

[mandysmith34]

I was on sotalol for a while and it caused huge issues with the QT interval. I was taken off it rather hurriedly and told i shouldn't have it again as it could cause big issues. But they never really explained what!!!

[SpritzerAce in reply to mandysmith34]

OK. Just out of curiosity do you know what your QT range was when they decided to take you off it?

[mandysmith34 in reply to SpritzerAce]

Im sorry I don't. All i remember is being hurriedly taken off it and told i mustn't take it again

[Cat04]

I've been on sotalol for 18 months (in UK) with no problems and AF adequately controlled by it.

[Spoiler]

I had a cardiac arrest on the second dose of tikosyn while in the hospital. The first pill converted me to NSR after only 2-3 hours and I was excited, then the next day after the second dose Torsadas rhythm preceding the arrest. Full code, then to emergency surgery I went for a temporary pacemaker. I am told it is rare. They also eliminated me from taking others drugs since that was my reaction, which includes solatol. I take flecainide 100 mg twice daily, metoprolo 25 mg twice daily and 5 mg. Warfarin.

[EngMac]

In Canada, the drug sheet states it should only be given the first time when monitored in a hospital for three days in case you flat line. They don't necessarily do this and my family doctor said it is too expensive in our public health care system; and anyway they only lose the odd person. I think if you have a left bundle block, the QT is lengthened and Sotalol would add to the danger. There are two kinds - Betaspace A and Betaspace B, one for the top of the heart and one for the bottom. They are not supposed to be wrongly prescribed. My doctor did not specify which one. I did not take it. Beta blockers do not agree with me. Been in ICU once when I was prescribed beta blockers; once is enough. Sometimes doctors do not consider all your specifics and make bad choices.

[SharonTyrrell]

I have been on sotolol for 3.5 years. By far the best drug that has worked for me. No issues with QT which was monitored. So far so good.

[SpritzerAce in reply to SharonTyrrell]

Thank you for the reply. Glad to know that it suits you. How often do you monitor your QT and do you know what is your QT range?

[deelan]

I have been on Sotalol for over 10 years; I am currently on the maximum dose of 160mgs twice a day (BD) and I am borderline QT measuring 480; my EP and according to documentation I am not classified as QT unless it reaches 500 (close). I have an ECG approximately every 6 months to check on it. I work in a health setting and to the best of my knowledge you are always admitted to hospital when starting on Sotalol (in the east in Victoria). Sotalol is still commonly used in Australia United States Canada and NZ it is often the drug of choice in these countries. As for prolonging the QT wave you will find many drugs have this or potentially have this effect.