Approx 4 months in to permanent AF (nothing prior!) and due for DCCV in the next few weeks. Various cocktails of drugs tried and have been on 160mg Sotalol + 125mg Digoxin as best rate control (rhythm still bad) for some weeks but EP wants to move me to 320mg Sotalol (no Digoxin) prior to and after DCCV to maximise chance of success. Previous experience on 240mg Sotalol alone showed limited rate or rhythm control + variety of minor but draining side effects. GP advised transition via 240mg Sot + 125Dig rather than direct to 320 Sot but all the same side effects are back within 2-3 days. (upset bowels, very tired, very breathless/weak, headaches etc).
Appreciate that everyone responds differently but do I just need to push through this and acclimatise? Is this something that goes away with time, or is this just going to get worse at 320mg dose? Thanks in advance for your experience
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ObiDyer
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Interesting that the doctor talking to our support group last night gave views on Sotalol. Given what you are experiencing it might be wise to get a second opinion from a consultant cardiologist.
Yes he said small doses ( someone had be prescribed privately but hadn’t started yet) were ok under supervision but large doses cause more potentially serious side effects He advised a second opinion as she was concerned
Hello Obi, I was that person expressing concern on the Surrey Zoom meeting over the advice I had been given by a Cardiologist to start Sotalol, for the same reasons given on here by ThomasLautus, namely the risk of undiagnosed prolonged QT interval leading to the serious arrhythmia Torsades do Pointes (a type of VT) which can lead to VF cardiac arrest.
New NICE guidelines 2022 appear to exclude Sotalol from all the other beta-blockers for initiation in primary care, which is where I would be prescribed. See
Having said that, I was told it was extremely effective in controlling paroxysmal AF and more cardio-specific than the Atenolol I currently take. On another recent Zoom group (Frome) an Arrhythmia Specialist Nurse told us it was widely used in Jersey where she works, so I do not want to alarm the many people taking this if it works successfully for them and advise no change in medication unless discussed with your doctor.
For me, starting it in hospital for monitoring would not be available, but I was told my ECG should be taken at the surgery 1 week after starting it to monitor the QT interval. However I am still not happy to go ahead and at present, would prefer to risk AF than the possibility of potential VF.
I wish you well with your DCCV Obi and hope it does the trick.
From what I understand, the side effects on Solatol are dose related, so it probably will get worse on the increased dose. I would ask your doctor for alternatives like Flecainide. Unless they are convincing, seek a second opinion.
Can you share your heart rate and blood pressure ? And you are on an anticoagulant ?
No one here is a medical professional, but from the facts you present it seems you are on a high combination of drugs. My experience, and others likely, is they begin with bisoprolol/metoprolol and progress from there to drugs like sotalol depending on each case.
The key is to control your heart rate and AF with limited side effects on quality of life.
I would encourage you to research the drugs that have been recommended and further consult with your GP and cardiologist. Sounds like they are not on the same page for dosage.
Appreciate that everyone responds differently but do I just need to push through this and acclimatise? Is this something that goes away with time, or is this just going to get worse at 320mg dose? Thanks in advance for your experience.
My experience while on Sotalol was it never controlled the rate without total exhaustion being present and I never had diminishing effects over the four years I was on it.
Nausea , exhaustion from any physical activity was ever present.
Not a drug I would ever consider taking again its just too debilitating.
I am on lowest dose of Sotalol (80mg/day to be taken 40mg AM and 40mg PM). This drug could cause Prolonged QT, which can induce Torsade de Point. I took this drug initially at hospital which then monitor my QT interval for 4 hrs, then 3 days later the Cardiologist monitor my ECG as well to check that the QT interval is within the SAFE range (must be under 500 ms). Any longer than that, this drug could be dangerous.
The recent comment from my cardiologist in France, on taking sotalol (80mg) was 'we don't prescribe that stuff any more'. Much of the 'stuff' on line tends to agree and sees it as an unhelpful beta blocker because it can have arrthymic as well as antiarrythmic properties.
I am in permanent arrythmia and had an ischaemic stroke two years ago but have been taking sotalol since 1995. Currently it works very well with me in controlling rate, with relatively few side effects, but every person is different.
I agree the best advice is to seek advice from another consultant or even pay for a short consultation with an online cardiologist (but make sure you are getting a fully qualified professional with a good reputation.. there are charlatans out there.)
As you are in the UK I found a video consultation with Dr Boon Lim very helpful at a particularly difficult time. But it is quite expensive, but you cannot put a price on getting the best possible advice.
Hello, I am on sotalol 80mg twice a day, I was able to decrease it to once a day for the last 6 months until recently when my afib episodes came back. I made the mistake of dicreasing too much the magnesium and potassium in my food. It was started while hospitalized on a heart monitor. My main side effects are blurry eyes while staring too long at the computer and poor blood circulation in my fingers which is really uncomfortable in our cold and long winter. But with an adjusted diet, it keeps me out of afib which protects me of sustained ventricular tachychardia.
Not a drug I have any experience of or would want ever to take and that was from advice from an AFA doctor giving a presentation who warned me about the antiarrythmic affects.
I agree with the advice to get a second opinion.
My view, very personal, is that if a drug is giving you the side effects you are experiencing then that’s not a drug your body is tolerating and if it ain’t helping, why continue?
Hi all,I am 65 live in UK, diagnosed with asymptomatic persistent AFib in August 2021, initially prescribed Apixaban / Equilis (my blood clot insurance policy) and Bisoprolol. They helped and after a short term successful DC Cardioversion realised what NSR actually feels like.
In December 2021, following an Electrocardiogram my Consultant prescribed additional Flecanide.
This improved my Persistent to Paroxymal AFib but left me fatigued, listless and with tremors.
In March 2022 my Consultant replaced my Bisoprolol and Flecanide with 40mg x 2 Sotolol which has proved to be near perfect for me.
My fatigue and tremors have gone, my NSR heart rate is now 55-75 bpm, my blood pressure is normal for my age, my episodes of AFib have reduced to only 2-3 day spells in any 14 days or more.
My ablation is scheduled for 23rd June in St Barts.
Hi im new to this im currently on sotalol 320 a day for afib and was cardioverted over a year ago but still getting chest aches and upper body pains got all tests done and they say it not heart cud it b the sotalol ive asked them this they say no but these aches only started after the cardioversion and since on the sotalol
I just think we all react differently and the only way to find out is to try it. I couldn't tolerate bisoprolol, metaprolol or flecainide and then tried Sotalol. I'm on 40mg three times a day and have been for a couple of years. Amazingly I feel a lot better than on the other medications.
I am in touch with EP/Cardio/GP etc and was just after background info to support discussions. Have reverted to 2x80mg sotalol + 1 x 125mg digoxin (which works ok for me) and told them to find a different anti-arrhythmic solution... awaiting feedback!
Yes everyone is very different. We tried Sotolol first before ablation. Drs gave me no choice. Undiagnosed afib gave me a stroke end of last year. I react horribly to most chemical drugs. Sotolol was the drug from hell for me. They forgot to mention it is contraindicated for asthmatics. I have mild asthma but have not had any issues for 10 years. Second dose of Sotolol threw me into the worst bronchial spasms and pain. Gutted it out for 3 days in the hospital at 240mg. (I am a tiny woman at 113 pounds nowadays after all this). Remained in strong afib complicated now with asthma. Third day they finally cardioverted me and that was successful. However the side effects of Sotolol continued to increase. Bad enough I was at ER within 12 hours with all the side effects. By the time I got to my regular doctor, I was back in 100% afib within 24 hours of my cardioversion. The side effects of Sotolol were so horrible for me, I could not remain at 240 mgs so I tritrated down since I was back in afib anyway. The cardiologist I was given was very arrogant, cold, and condescending and his personality matched the drug last side effects. I fired him and saw a cardiology arrhythmia surgeon specialist who is excellent and lucky for me loves a challenge. My first ablation was successful but incredibly challenging. After five failed cardioversions, he ended up doing my ablation with me in full afib. Still, recovery was nothing as bad as the sotolol experience. He also discovered my vessels take the scenic route to my heart and my left atrium was much smaller than anyone knew once inside so the entire back side of my heart was also treated. Like everyone else he said I will a second one at some point in my life. For me, the chemicals are a major fail. I went back to Propranolol for my HBP and remain on Eliquis because of the stroke and clotting issues. Hopefully someone else will comment with a good Sotolol experience... if you are already having serious bad side effects on a lower dose, I would expect that will continue or perhaps worsen. Please talk to your pharmacist regarding ALL of Sotolol's contraindications and side effects. My first cardiologist failed me miserably and I fired him and his incompetent office. Be sure to be completely informed. I may have had a better experience with a good Dr and titrating up but as I said, chemicals and pharmaceuticals I don't do well together at all. Good luck!! Wish I could tell you differently. Always be as informed as possible. You are your own best advocate.
Sorry to hear that Sotalol was so bad for you. But I was replying to sympathise with your experience with such an arrogant and unfriendly cardiologist, as I have just had a similar experience. He shouted at me, berated me and left me with a BP of 180 over 100, hardly the manner of health professional. He refused to answer any of my questions or explain what was the nature of the drug he recommended. People like this should not be in the health profession and I wonder why they entered a caring profession in the first place. Luckily, I did not need to 'sack' mine but I will not waste my time seeing him again and will go to another cardiologist who has a better reputation. I hope you can find a much more complete recovery very soon.
💖 thank you so very much oscarfox49 for your support and caring thoughts! Sadly I have become quite good at firing doctors over the last 10 years. I have found treatment from "professionals & specialists" to be quite substandard and even demeaning if you have a condition or body that does not respond as textbook taught in schools or fits into such "experts" thinking and experience. The ones I have the worst experiences with are those with egos so I can only assume they entered into their field of choice due to their feelings of superiority because that is the note it comes to when I choose to leave. I accept what is broken and I cannot fix. It's taken me most of my life to realize I am of worth, value, and deserve to be cared for as a complete person. I no longer waste my time on those who have no intention of helping me if it means they may have to admit they are not fully capable and or have become so callous to those they are to help. I have been blessed beyond measure to find some very caring individuals along my journey and the negative experiences simply teach me to treasure them all that much more ❣In posting my feelings & experiences, I hope to give courage and encouragement not one of must suffer as some of us have. There is hope and care, it may take quite a bit of perseverance and tenacity but we are definitely deserving and worth it as we each strive to gain and live a full life to the best of our abilities. It can be frustrating when those who possibly hold the keys to our wellbeing may be our biggest deterrents and detrimental to our health. Bottom line for me is there is hope and help which is why I visit here. TOGETHER we are Stronger 🙌 helping, understanding and leaning on each other. Someday will be harder than other days 😊 but together we will make it.
I am on sotalol 80mg twice a day. It works as long as I adjust my diet with more magnesium and potassium, and stop gluten and alcohol. The side effects are blurry eyes while staring too long at the computer and poor blood circulation in my fingers when cold.
I was given Sotolol by my GP when I first was diagnosed with AF and when I had a bad episode and was in hospital the cardiologist who treated me immediately took me off it as it was found to have lengthened my QT interval. He prescribed Bisoprolol instead. I didn't have many side effects with the Sotolol but the Bisoprolol was awful. I changed it to Nebivolol and have been on that since.
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