Been to back to the hospital today and it sounds like good news.
They have taken me off Bisoprolol and put me on Sotalol (40 mg twice a day). I am so pleased to be off Bisoprolol. I don't want that to put others off from taking it as it ticks the boxes (for me) regarding lowering my HR. We are all different of course and it might be ok for you.
Now I have a copy of the letter sent by my cardio to my GP as I type.
The next step is an echocardiogram to 'assess his left atrium size before proceeding to DC cardioversion'.
Should be fine.
Checked Sotalol out online - it appears to be a cross between a beta blocker and antiarrhythmic med. I know we can't give medical advice but just wondering how others got on with it ? Saying that it seems to be 50 / 50 but count me in for now.
I must say though I'm delighted to be off Bisoprolol. Let's see how this one goes
Paul
Ps - 'it appears to be a cross between a beta blocker and antiarrhythmic med'. That's the one I really want to know.
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Hi Paulbounce,Welcome to the Sotalol club. I have been taking Sotalol for 20 or so years. I have tried Flecainide and other drugs but always returned to Sotalol. I take 2 X 80mg per day. Have been up to 2 X 160mg per day! Your dosage is the lowest dose and does not have any anti-arrythymic properties at that dose. Mainly some small impact on BP and lowering of heartrate.
I also carry it as a PiP (80mg) but it doesnt work very well in that mode.
Thanks Glad for your reply. Great news it's working for you - long may it continue.
Think I may have the answer to my question.
Type III antiarrhythmic action
Sotalol also acts on potassium channels and causes a delay in relaxation of the ventricles.[13] By blocking these potassium channels, sotalol inhibits efflux of K+ ions, which results in an increase in the time before another electrical signal can be generated in ventricular myocytes.[11] This increase in the period before a new signal for contraction is generated, helps to correct arrhythmias by reducing the potential for premature or abnormal contraction of the ventricles but also prolongs the frequency of ventricular contraction to help treat tachycardia.
I doubt it will put me back in to sinus but might help after a CV. Time will tell
Pleased it's working for you - sounds positive new's.
Yes, I also have been off and on taking Sotalol for the past 10 years and have tolerated it well. Two years ago I was put on to Flecainide, which had really horrible side effects. Had breathing problems, muscle weakness and I finished up feeling very depressed and debilitated. Even dropped my regular pilates and fitness classes. Figured the treatment was worse than the Afib. The cardiologist finally agreed to put me back on to Sotalol 2X80mg per day. I am back to all my classes and am enjoying life!
I've been on Sotalol on and off in the dim and distant past ( I've been on the whole lot....) and can't remember any problems with it. Unlike Bisoprolol which I absolutely hate .Good luck !
Many years ago I took Sotalol as a pill in the pocket and it would calm my heart but make me feel spaced out. I took it briefly after my second ablation, but it didn't stop my AF attacks and I went back on to Flecainide. For some reason my EP doesn't like Flecainide and told me to try and reduce my daily dose from 2 x 100mg to less, even if it meant increasing my beta blocker Metoprolol which has a really strong effect on me. My Metoprolol was increased once while in hospital, they gave me 100mg one night, in an effort to bring my heart rate down and I collapsed next day. My AF nurse said I must never have more than 12.5mg as it could kill me.
It's so odd how we all respond differently to medication.
I'd just see how you get on with Sotalol and who knows it could be your wonder drug.
Thanks Jean. I hope it works too but only time will tell I guess. I'll certainly keep my eye open this weekend for any side effects. Hopefully all will ok as it's a small dose. I hope all is good with you
Good lord, 100 mg of metoprolol would sink me too! I was on it for a while. That EP suggested 50 mg of it. I refused after hearing my brother describe that a 50 mg dose knocked him off his feet. I did take 25 mg of it for awhile, but then switched to a new EP after the first one just kept telling me that there was nothing wrong me. 🤬 The 2nd EP suggested ablation and flecainide, which worked well for a while, felt like my old self on that, like you. Then another ablation and sotalol was his next best guess. 40 mg was ok, but wasn’t stopping the afib. So that dr gave up on me. Enter EP #3, who is terrific, but upped the sotalol to the point where I’m tired and dizzy all the time. And like your dr, this one doesn’t seem to like Flecainide. Amazing how differently we all react. But sounds like you and I have some similarities!
Hope it’s helping you Paul. My EP wouldn’t let me stay on that low a dose. And I’m not happy on a higher dose. Crazy how we all react so differently. Good luck!!👍
If you can't access it in the State's I'll copy and paste below. It doesn't make for good reading TBH but there are many positive's for Sotalol on the thread. Sounds like a toss of the coin to me but I'm going for the positive side - you have to really.
May I also suggest downloading a VPN - this will allow you to access sites from another country. Some you pay for and some are free but have a limit on the useage.
Paul
How is sotalol initiated, and what is the usual maintenance dose?
Sotalol is usually initiated and titrated up to an appropriate dose in secondary care. However, a primary care practitioner may be expected to continue prescribing sotalol and monitor for adverse effects (depending on locally agreed shared care guidelines).
The usual maintenance dose of sotalol is 160 mg to 320 mg twice a day.
[Joint Formulary Committee, 2019]
What adverse effects are associated with sotalol?
Sotalol may aggravate a pre-existing arrhythmia, provoke a new arrhythmia, or cause torsades de pointes arrhythmia (increased risk in women) [ABPI, 2018c; Joint Formulary Committee, 2019].
Sotalol may also cause similar adverse effects to those of other beta-blockers. See Adverse effects of beta-blockers for more information.
What key drug interactions should I be aware of for sotalol?
Sotalol prolongs the QT interval, and only specialists should co-prescribe drugs that prolong the QT interval. This is because of the risk of additive effects, which may lead to serious and potentially life-threatening torsades de pointes arrhythmias. Examples of drugs known to have a high risk of causing QT prolongation include [Preston, 2016] :
Antiarrhythmics, such as amiodarone, disopyramide, and quinidine.
Antihistamines, such as astemizole and terfenadine.
Antipsychotics, such as amisulpride, haloperidol, and droperidol.
Antibiotics, such as erythromycin and clarithromycin.
Antidepressants, such as citalopram, escitalopram, clomipramine, and amitriptyline; and lithium.
Sotalol may also interact with other drugs (in common with other beta-blockers). See Drug interactions with beta-blockers for more information.
I also had problems with Bisoprolol and was given Sotalol. I started with 40mg twice a day but after discussing it with my EP decided to try three times a day. First thing, after lunch and after dinner. Meals really affected my symptoms so presume my afib is vagal. I have been on it nine months now and am much better than I was after eating. I have days where I'm breathless but nowhere near as much as when I was on Bisoprolol. I am going for my first ablation next week, so one day in the future I may just end up coming off Sotalol. Anyway generally I have felt better on Sotalol.
Hi Paul. Yes I usually take them just after lunch and dinner, but the first one of the day I take as soon as I wake up. I didn't get advice as to when to take them so it was just trial and error to find out what suited me.
I liked Soltalol as it suited me better than Bisoprolol but after a couple of years it stopped working for me and my heart rate went very high. Back on Bisoprolol Dejoxin and Entresto now to help my heart pump better.
Glad to say my visit to Stoke was cancelled. They rang me and said they wanted me to have ECG at stafford that morning then Dr Beynon my consultant rang me in afternoon. He wants me to have Digoxin levels checked with a blood test then have another Eckocardiogram to see how well my heart is now pumping. I mentioned a pacemaker but pacemakers not good for fast heart rate unless they completely disable my heart electrics function so I would then become completely reliant on the pacemaker. But if that were to fail that’s me done. So don’t fancy that. Just hope they can get my medication sorted as don’t like being tired and feeling rough a lot of the time ☹️☹️
This sounds like a positive move although I don't know anything about the drug itself. Really hope it's a good interim solution for you while you're waiting for your cardioversion.
Everyone is different so don’t be alarmed by my response. I am a very fit and active person, but when on Sotalol each day I become more lethargic and after a few weeks I just wanted to lie down all day and struggled thinking about doing simple tasks like emptying the dishwasher. I dreaded taking th tablet each day.
From within 24 hrs of being taken off Sotalol I felt more energetic. I was put on Amiodarone until my Catheter ablation next year, and have zero side-effects and have ALL my energy back.
Only YOUR body knows how you will react so comparisons aren’t useful - unless you show similar side effects.
Amiodarone can have bad long term side effects on your thyroid and lungs so make sure you get thyroid checks done. My consultant has taken me off it as been on it for a while.
I took Sotalol for a couple of years prior to having my ablation, great drug, kept the AF away while I waited, no side effects. I had been admitted to hosp in AF and after 4 days there on sotalol I reverted to NSR Prescribed by EP. Best wishes.
It is easy to be bogged down by negative info but if your EP/cardiologist has prescribed sotalol then it's because they think it is best for you and your condition. They will not deliberately give you something to cause harm or ill effects without giving you some benefits . Trust them unless you can prove them different 😉
Hi Paul, I take Sotalol....Flecainide/Bisopralol doesn’t suit me. It took me several months to get used to it and as with all beta blockers I still feel mildly “held back” when exercising but overall my quality of life is better with Sotalol than with F/B. Hope it suits you too.😁
OK Patsy. Good luck with your ablation - are you having it for atrial fibrillation and / or flutter ?
Paul
You are on a low dose of Sotalol which shouldn’t cause you problems. Usually they start you off on a low dose to see how you react to it, so it might be increased later. Mine was increased from 2x40mg to 2x60mg. It’s an older drug but it’s still widely used. I’ve taken it for nearly three years without any problems.
Samazeuilh, may I ask how you take 60mg? I take 40mg twice a day and have to cut a tiny 80mg tablet in half to get the 40. I have no idea how I could ever cut it to make 60mg. I live in the states and we don’t have the 40mg tabs here. Thanks!!
Oh thanks lovetogarden, glad to know I’m not alone in the dosage thing. Great idea about the 120’s. I hadn’t realized the strengths that Sotalol came in until now. I appreciate your taking time to respond.
Hi Paulbounce, my EP put me on Sotalol 40mg twice daily and unless it's that which is causing my upper body pain (which I don't think it is) I am fine with it! I took flecainide and bisoprolol before and they didn't work for me either. Good luck
Hello Paul, glad to hear you are feeling so positive about your new medication, I have been taking Sotalol for 18 years, I have had no problems with it so far, I do get a bit breathless at times, it my doctor thinks it is not the Sotalol
I was on Sotalol for a short period to lower the BP and my Cardiologist said it was one of the better beta blockers to keep me in sinus rhythmDidn’t work for me and was very hard to take, cardiologist and pharmacist stressed that it must be taken 1/2 before a meal or 2 hours after a meal which I found troublesome when it is a twice daily administration (12 hourly)
Ty Dizzy. I asked the pharmacist about taking it with food and she said it didn't matter ? I guess though it will be aborbed much quicker on an empty stomach.
Hi Paul again, I was told with or without food and it also says you can do this in the information leaflet. I take mine around 7am - 7.30am and 6.30pm - 7.00pm at night irrespective of when I eat
Interesting, my instructions from the pharmacist says to take the Sotalol either with or without food but then keep it that way, don’t change it up. In other words, either always take it with food or always on an empty stomach. I suppose this is to affect absorption the same each day. It’s hard to do this because when I take my evening pill at 10pm, I have to eat something at the same time.
Hi totally agree you are unique and not every treatment option works. I have been on Sotalol 2x 60mg daily for 5 months AF free. However was heavily debilitated and physically limited but as my body has adapted to the drug as my Cardiologist said this has and still is improving. My quality of life has greatly improved and heart strength improved greatly as I build up activity. I take supplements drink lots water avoid source sugar and reduced carbs eating green and clean. Absolutely no alcohol or caffeine. Very very happy to be in Sinus and doing everything to avoid trigger for AF. Hope your treatment is effective I could not handle metapropolol or bisoptopolok bpm from resting 180 to 32 now a steady 55 and no ectopics. Good luck be persistent and patient give your body time to adjust. Regards.
Hi Paulbounce, I wish you every luck that this works for you! It didn’t work for myself but I’m keen to state that it does for many so the only way is to suck it & see I guess? I ended up stuck on it for a couple of extra months due to not being able to raise my cardiologist too because of Covid. In hindsight I should’ve just gone to my GP but didn’t want to circumnavigate the expert (not realising how badly it had affected me by then). Completely my own error!
I ended up back on Bisoprolol with the addition of Flecainide which I’m quite liking at the moment. Previously the Flec wasn’t an option because of heart health, so worth noting that Sotolol hadn’t caused any problems there.
Been talking 40 twice a day for 13 years for paroxysmal atrial fibrillation - has been effective, and still seems to be working - long may that continue! Hope all goes well for you.
Indeed Wildcat - long may that continue. Good to hear and I hope to be the same. If I could get another couple of years of being in sinus on it I will be well happy. 13 years would be like a lottery win
Both would be better still heh. Maybe I'll start buying a lottery ticket
Sotalol is GREAT! Zero side effects and pretty much keeps me in sinus rhythm. I do have occasional “breakthroughs” but they last under one hour. I highly recommend it. My QT interval is fine. I am on a very low dosage. I take it twice per day ... precisely 8am and precisely 8pm ... my Alexa device reminds me!
Hi have been good with same sotalol for 2 years but recently eye bleed cases. Macula damage and loss of focus. Have heard Sotalol may be increasing risk of this. Have you heard anything about this. Something to be aware off perhaps. Then it may just have been bad luck for me and unrelated. Thanks for your previous post on this which assured me all could be good and it has been
Hi,I was diagnosed with Afib in January. I started with 40 mgs of Sotalol 2X per day but it had no effect on Afib. Dosage increased to 80mgs 2 X per day put me in sinus rhythm for 5 days. Bumped up to 120 mgs per day and had awful side effects of shortness of breath, low heart rate, nausea, fatigue, etc. had Cardioversion in March. Doctor reduced dosage of Sotalol back to 80 mgs and went back into Afib after 2 weeks. I am now taking magnesium supplements along with the 80 mgs of Sotalol. I have less side effects on that dosage and the magnesium helps with heart palpitations and arrhythmias.
"I am now taking magnesium supplements along with the 80 mgs of Sotalol. I have less side effects on that dosage and the magnesium helps with heart palpitations and arrhythmias"
Magnesium comes highly recommended on the forum. I haven't taken any for ages - maybe it's time to buy some more.
Sounds like it works for you - what dose do you take daily ?
I take 500mg Mag Glycinate per day and 200mg of Ubiquinol per day. I am convinced that they significant assist the Sotalol to keep me arrythmia-free.....
Was on many drugs for afib, finally ended up on sotalol, It was great for me, but my dose had to be adjusted as it would slow my heart rate to low. It was perfect in controlling and lowering heart rate. After 3 years the doctor slowly reduced to 20mg morning twice a day I am now off all meds except the bloods thinner. Everyone is different but sotalol was wonderful in controlling the symptoms and sickness I felt because of afib.
I have also been taking Sotalol 40mg twice daily for 3 years and doing well on it. However, I recently started having lots more ectopics etc. even tho’ I take magnesium. In January I had to start on anastrozole following breast cancer and that drug can cause heart arrhythmias so I think it has aggravated my condition. I may do a separate post on that soon to see what others have found. Hoping Sotalol will work for you as it has for me regarding the atrial fibrillation! Good luck!
That’s interesting. I think the AF for me was alsoKicked off by the anastrozole and this is the first time I’ve seen someone make reverence to me. I guess something that we will never know. After having bilateral mastectomy I thought that would have been the end of it but clearly not as a year later I was diagnosed with AF under a routine echo. I’m currently on flec/bisoprolol for the PAF.
"In January I had to start on anastrozole following breast cancer and that drug can cause heart arrhythmias so I think it has aggravated my condition. I may do a separate post on that soon to see what others have found".
I think you should start a separate post - I'm sure other's will be able to help with their experiences. I'm sorry to hear to have suffered from both cancer and afib. Not a good combo.
I think you are very brave and really wish you all the best sweetheart. Get through it and you'll get through anything life throws at you.
Hi Paul, It was the first drug I was put on after being diagnosed with PAfib. I didn't have any side effects but still had episodes of Afib every 3 or 4 months that lasted about 12/24 hours. Cardiologist changed me to Flec and Bisoprolol. Episodes became more frequent but lasted much less time -max 5 hours but mainly 2 or 3 hours but pretty much symptomless - this combination got rid of my PVCs too (the ones I could really feel and really plagued me as much as the Afib). But since I have upped my dose of Vit D and started to take extra Vit C my episodes have become a little more spaced apart. Maybe just coincidence - but I can really feel a difference since I started those supplements with of course magnesium! All that to say I didnt have any side effects on Sotalol at all except maybe the Premature Ventricular Contractions. Getting up hills since being on Bisoprolol is a bit tougher and I have far more vivid dreams at night :(Take care X
Bisoprol made me exceedingly ill -the worst of thelot. All the beta blockers are bad epsecially if you have an underactive thyroid as they inhibit the conversion of thyroid hormomes -thats how they work. This causes the heart rate to slow down alongside many other body functions causing fatigue, constipation etc.... Im on Verapamil and that works pretty well for me. Hope you get sorted Paul.....we are all different. What works for one doesnt work for others.
"we are all different. What works for one doesnt work for others"
Very true - sounds like Verapamil works well for you. I too didn't see eye to eye with Bisoprol ! Seems to be trial and error with these med's. Hopefully the Verapamil will continue to work for you
I took Sotalol for two years some time ago. Then I went on to Bisoprolol. Both these drugs badly affected my sleeping with nightmares and left me feeling so ill. The Sotolol prolonged the QT rate of my heart as well. I then went on to the BB Nebivolol and that has been my saviour. I believe that 4 or 5 years ago NICE took Sotolol off the approved list for treating AF but perhaps they altered that now. However as you say we are all different in the way we react to drugs. Good luck for the future.
I'm pleased Neboivlol works for you. I'm pretty sure your right about NICE taking Sotolol off the approved list some years back. I also wish you good luck and hope the Nebivolol carries on ticking the boxes
I was put on Sotalol 40 mgs twice daily for SVT about 15 or more years ago. It almost stopped the SVT and it would only last a short time when I got it. Then in 2014, I got a nasty coughing virus and it caused my first episode of AFib. They kept me on Sotalol and I have had 2 more episodes of A fib since then. It seems to be caused by infections. I have had no problems with the Sotalol, except when I first started it, when I was in hospital with the SVT. They gave me too high a dose and it made me very dizzy and I could hardly stand, so they reduced it to what I take now and I ‘ve been fine on it. Only thing that worries me, is the huge amount of drugs reactions you can get with it. I have a list on my phone which NICE produced and always check it before I take anything or when I am prescribed medication for anything.
"Only thing that worries me, is the huge amount of drugs reactions you can get with it"
I'll check this out - might be a good idea.
You are 100% right that infection can cause afib. It does though sound that it has worked for you overall - that's good news. The only thing I find with it is that my HR is higher at rest than it was on Bisoprlol. I would like it lower but have to accept it for now I guess
Cracking news at the moment. HR dropped from 85 - 90 to 69 when I checked earlier at rest. Really chuffed - however I have no idea if it will be the same tomorrow.
How are you today, Paul? Doing a little better I hope. Please let us all know what they find out about the left atrium size. Mine is severely enlarged but Cardioversion worked well for me. I have also now had an ablation which has more or less worked well as a treatment. I may even be able to have a second ablation too. I obtained advice and a letter from a well thought of private electro physiologist ( cost around £250 for advice ) in order to prompt NHS to review my case and offer cardioversion first and if that worked, then try ablation. I know I’m heading for a pacemaker and the full pace and abate. Technology is improving dramatically and I want to buy time and only have the pace and ablate as a last resort.
Too much about me- back to you and your health. Take things easy Paul and proceed step by step. Members of this most amazing forum will be holding your hand and will help you through what we know to be a “ journey”.
Thank you so much for that reply - I really appreciate your kind words.
"Technology is improving dramatically and I want to buy time"
I feel the same - hence why I would like another CV rather than ablation. I certainly look on the positive side regarding this.
I feel ok as my body is adjusting to being back in afib. Still little energy though and don't want to do much. However we have all being there and have to move forward I guess. I must say though it has hit me this time - more than before.
I delighted your ablation seems to be working - well done and enjoy your day
Hi again PaulAre you able to pay for a telephone conversation with a top class EP? I’m not sure how to send you a private message. Also the choice is yours - stick with cardioversion or opt for an ablation. I was advised by top EP that ablation offered the best chance of better quality of life. The longer you are in afib apparently the harder afib is to deal with. You know the adage
“Afib begets afib”. BUT remember also “sinus rhythm begets sinus rhythm”. The new book “ The Afib Cure” is superb though mistitled. The authors talk about achieving remission. Really, really, brilliant advice offered.
I have bouts of aflutter now and may have a second ablation OR choose instead “pace and ablate”.
My understanding is that an ablation for flutter has a really good chance of success. It's certainly worth you looking in to this.
Many suggest reading the book "Afib Cure". I really must order a copy.
Now ablation or CV ? I've had two years of sinus from my last CV + med's. My gut say's to go through the route of another CV + med's and this is what I have requested. If I can pull another 2 years out of the hat great news. I do of course know it could be just a few hours in sinus. This is a chance I take and I have given it some thought.
So why not ablation ?
You wrote
"Technology is improving dramatically"
100% agree. Already an ablation has a better chance of success than a few years ago. The new mapping technic's can 'hit the spot' so to speak. Personally I think given a few more years they will improve even more. There are many who have had an ablation and it works wonders. There are also many who have had 4 or 5 but are now in permanant afib. Works for some but not for others. It's to hit and miss for my liking. I certainly don't want that to put people off if their EP has recommended one - it makes a positive difference for many.
Maybe I'm making the right call about another CV rather than an ablation - equally I could be making the wrong call. Only time will tell. However that's how I feel at the moment.
I know many on the forum recommend the ablation route to treat afib - I fully respect their opinions. From a personal point of view I want to hold fire a little longer. That's just me and I know I could be totally wrong.
Really useful information for myself as just been prescribed Sotalol 40mg twice daily for upcoming Cardioversion leading to possible Ablation..some say knowledge is power but that many differing opinions and reactions can lead to confusion and it’s our own personal reaction to any medication that’s counts.Quality of life is to me all that matters and to be honest my quality of life is just fine I can walk for miles without issue I cycle some days 20 miles plus I lead a healthy lifestyle I eat well ,Take alcohol infrequently and have never smoked and I sleep extremely well..I don’t feel I have any AF symptoms whatsoever my pulse is consistent between 75-80 blood pressure around 115/75…my AF was discovered whilst undergoing knee surgery and I am currently prescribed Losartan/Edixaban/Bisoprolol now being switched to Sotalol..having just turned 65 I guess my risk has now increased ..seeing an EP as recommended by many has proved difficult through normal channels, I am interested to hear if any members have had an Electrophysiological study rather than a brief meeting with an EP..I have tried searching the form but unable to find any results..The taking of the prescribed drugs is my main concern.
It sounds like you are doing well Steve - very well indeed.
40 mg is the starter dose - mine has just being upped to 80 mg twice a day ready for a CV (I hope).
"I am interested to hear if any members have had an Electrophysiological study rather than a brief meeting with an EP".
Interesting question - one I'll follow with interest.
Now for me personally I want to hold fire on an ablation just now. That's solely my personal decision and based on the technic's improving all the time. Maybe I'll live to regret it with hindsite - who knows. However with a good QOL I wouldn't do it - not just yet anyway.
I really don't want that comment to put others off. It can work for many (and it does) but if possible I want to hold fire a little longer. If (and it's a big if) I can get another few years out of med's and a CV I will be more than happy. I'm realistic about it and fully aware it's not likely to happen (it did last time though - I should be more positive). However just assuming I can get another year or so in sinus I feel ablation technic's will have improved greatly by then - they already are and new way's of doing it are coming as I type this post.
Given your age you'll remember the Clash song 'Should I Stay or Should I Go'.
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