Scytalol A

Sotalol was developed as a nonselective beta-blocker in the 1960s for the treatment of hypertension and later for cardiac risk management after myocardial infarction. Extensive research has since well described class III type electrophysiologic effects on the repolarization of myocardial fibers. Sotalol prolongs and homogenizes ventricular refractoriness, resulting in good antifibrillatory/antitachycardia protection. The unique combination of beta-blockade and antiarrhythmic effects probably will promote sotalol's use in postmyocardial infarction patients with ventricular tachycardia and sudden death. This article summarizes the pharmacologic and cardiovascular effects of this new drug, outlining its clinical use.

Background: Dose-dependent QT prolongation with class III antiarrhythmics mandates close monitoring often in an inpatient setting. Outpatient sotalol loading monitor provides an alternative to patients that is cost effective and allows preservation of hospital resources. Objectives: The objectives for this study include assessing adverse events, assessing patient adherence to monitoring and follow-up, comparing hospital cost and resource utilization, and evaluating patient satisfaction with outpatient sotalol loading program. Practice description: One pharmacist in the antiarrhythmic clinic at OhioHealth Riverside Methodist Hospital completed 3-day outpatient sotalol loads under a collaborative practice agreement. Clinic services included pharmacotherapy management, medication counseling, and device education. Practice innovation: This service allows pharmacists to provide direct patient monitoring to provide increased patient access. Evaluation methods: All data were collected via the electronic medical record, patient journal documentation, and a patient satisfaction survey. Results: A total of 12 patients completed outpatient sotalol loading; 10 patients started in normal sinus rhythm, and 1 patient was cardioverted during the load. No patients experienced any adverse events during the loading phase. One patient completed a successful dose increase during the loading phase. All 12 patients attended the first visit, completed baseline laboratory tests, and uploaded electrocardiograms for all 3 days. A total of 11 patients were evaluated as a cost comparison for inpatient sotalol loading. On average, outpatient loading cost was $886.30, in comparison with $7571.76 for inpatient loading (P < 0.001). A total of 10 patients completed the satisfaction survey, and all of the patients preferred to complete this in the outpatient setting. Conclusion: In this study, 12 patients safely completed outpatient sotalol loading, with an overall decrease in the cost of their care in comparison with inpatient loading. This study showed that pharmacists can serve as physician extenders to continue to provide high-quality and safe care to patients in the antiarrhythmic space.

Sotalol is a water-soluble, nonselective, beta-adrenergic blocker that was recently approved in oral form in the United States for the treatment of ventricular arrhythmias that are judged to be life-threatening. As a beta-blocker, sotalol is unique in having additional class-III antiarrhythmic activity. It is still not resolved whether sotalol is more effective than other beta-blockers in managing arrhythmias, but there are suggestions that it might possess greater antiarrhythmic and life-protecting activities than other types of antiarrhythmic drugs. The drug is well tolerated, but, because of its electrophysiologic activity, there is a small risk of proarrhythmia, specifically the development of polymorphic ventricular tachycardia and torsade de pointes.