Sotalol

[nmack]

Hi, all. I had an ablation for persistent afib 14 months ago and was in NSR until last month. I was put back on Sotalol 80mg and am back in NSR but they are recommending another ablation to get me off Sotalol. I know it's not the safest medication but is anyone aware of long term problems from Sotalol usage and does it eventually stop working for some people? I turn 70 in July. Thanks.

[CDreamer]

Like any substance, our reactions to drugs are individual but yes, I was warned off Sotolol because of lasting harmful affects. Not a drug I would was willing to take but that is very personal. Very serious affects are rare but like anything else, nothing is risk free - ask your doctors about the risks. Sometimes I have asked ‘If you were in ny position what would YOU do?’

My questions would be:-

You say ‘back on Sotolol’ so presumably you have taken it before? Who advised you go back on Sotolol - GP or EP? Was it affective at stopping your AF? How symptomatic were/are you in AF? What are the chances of another ablation working for you and is that what you want? Has any other treatment options been suggested and if so what do you think of the alternatives? There are often options.

All treatments for AF manage symptoms - there is no known, long lasting ‘cure’ so sometimes it’s about choosing the least objectionable option and some people find they can live well in persistent AF if their HR is reasonable and/or managed.

Hope you find some answers.

[BobD Volunteer]

Sotolol is not a nice drug and whilst it can't "stop working" in the way that say narcotics do becuase there are no receptors in the body for it I would not want to remain on such a nasty drug for any length of time.

Ablation does seem a good option and having had one already what is your objection? It is not uncommon to need as second or even third over time.

[mav7 in reply to BobD]

can't "stop working" in the way that say narcotics do becuase there are no receptors in the body for it

From past reading, I share your concern Bob. Can you please explain what is meant by "can't stop working" and "no receptors" ? Thanks !

[BobD Volunteer in reply to mav7]

If a drug attaches to a receptor in the body the way narcotics do to pain receptors then over time you need more drug and more drug as the receptors increase so the effect is reduced. The drug is therefor addictive ( most opiates like codeine for example) . Anti arrhythmic drugs work by blocking parts of the electrical system.

AF is always a progressive condition as I am sure you know, since each rogue pathway can multiply and form new ones . Since there is a poison level for all drugs, what happens is that eventually you need more drug to deal with the pathways than permitted. The drug has not stopped working but your AF has increased in intensity.

There are people here who have taken flecainide for many years and by controlling the AF, new pathways have not formed so it continues to work. Lucky them!

[mav7 in reply to BobD]

Thanks for great answer !

[Karendeena in reply to BobD]

Hi Bob, my EP who is highly respected in the UK has had me on sotalol for over 2 years, he never mentioned that it's considered unsafe long term. What are supposed to be the problem with it. My EP says it's one of the best!!

[BobD Volunteer in reply to Karendeena]

Horse for courses. Not all EPs would agree from my experience though I never said it was unsafe, just not one I wanted to be on long term. Always best to find ways NOT to be on drugs where possible.

[Karendeena in reply to BobD]

I agree Bob, I have my name down on the long wait for an ablation but must admit it scares me to have a wire through my heart ❤️

[BobD Volunteer in reply to Karendeena]

As a devout coward trust me when I say it is a non event. I think a visit to the dentist is far worse.

[Karendeena in reply to BobD]

Cheers Bob 🙂

[MrsSuzuki]

Interesting to see the replies about the nasty long term effects of Sotolol.

My husband has been on it for over 12 years and has had no issues with it whatsoever. He tried a few different types before taking Sotolol and nothing seemed to help/or had too many side effects.

Lily

[Karendeena in reply to MrsSuzuki]

I am on it too and my EP recommends it. I am curious to see why it's considered to be a 'nasty' drug

[Paulbounce]

I too am interested in this thread. I was unaware of these long term side effects. Further investigation is required methinks!

Enjoy your day.

Paul

[AFCyclist]

I was put on 120mg of Sotolol twice a day a year ago by my EP and it has had a dramatic effect by eliminating my frequent bouts of AF to zero. My AF was occurring after cycling or stressful situations.I was not aware of it being a "nasty" drug or of long term effects. I have just had a review with my EP and we decided to cancel my ablation as I was going so well at the moment. Food for thought.

[Karendeena in reply to AFCyclist]

AFcyclist this is what I have been told. It's as safe as any.

[Windlepoons]

I reacted badly to everything prescribed until Sotalol. So far no problems after six years. We are all different! ☺️

[oscarfox49]

Sotalol is one of the safest drugs and is also one of the oldest so there is plenty of experience of it. All I can say is that I am 77 and have been taking 80 mg (40mg x2 a day) since 1995. Apart from the original 'beta blocker' reactions which were extremely difficult at the start, I have had no adverse effects and everything I have read has suggested that it is a safe drug (except in the sense that nothing is safe). Certainly compared to the alternatives which were prescribed to me after a stroke three years ago, the side effects are minimal.

[Dudtbin]

I am on sotalol, no problems at all. I was unaware of problems with it. It works!

[Lamsie]

Hi nmack

I take 320mg sotolol daily but had my AF ablation on Wed so that hopefully I can eventually stop this medication. I found it ineffective anyway the longer I took it - but think my AF just progressed.

[Sixtychick]

I’ve been on Sotalol for many years now and have no problems. I’ve had the dose increased 3 times and am now on 80mg in am and 120 mg in pm. I have yearly blood checks at Doctors surgery as well.

[55zuzanka61]

Sotalol has potential to cause dangerous ventricular tachycardia in small fraction of patients and that’s why it is often initiated in hospital with at least 48 hour monitoring of QT interval,making sure the drug does not prolong it.

Other than that Sotalol is very benign and safe drug for long term use Compared to other antiarrhytmics

55zuzanka61

[Bolander]

After a bad experience with Amiodarone I was put on Sotalol 80 mg twice a day and it has kept me in NSR for several years after a cardioversion. It also has the advantage of being both a rate control and rhythm control drug.

[mav7 in reply to Bolander]

Bolander May I ask if you were in persistent/permanent AF or paroxysmal prior to the cardioversion/Sotalol therapy ? Thanks !

[Bolander in reply to mav7]

I was originally diagnosed with atrial fibrillation but after a few years of intermittent attacks I was admitted to hospital where the diagnosis was changed to atrial flutter and had the cardioversion.

[mav7 in reply to Bolander]

Thanks !

[Karendeena]

My EP had me on Sotalol never mentioned it to be unsafe!!

[AFCyclist]

Interesting experiences. Perhaps Sotalol's bad press is undeserved? No doubt over the years time will tell me. An interesting side issue for me is that it lowers my resting heart rate to 50bpm where my pacemaker kicks in to keep me at 50bpm. Discussed this with my EP and he was quite happy.