Sotalol

Also indexed as: Betapace®

Sotalol is used to treat certain types of heart arrhythmia, and is in a family of drugs known as beta-adrenergic blockers.

Summary of Interactions with Vitamins, Herbs, and Foods
(for details about the summarized interactions, read the full article)

Beneficial May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Magnesium
Avoid Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.

Antacids

Calcium supplements

Food

Milk
Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

High-potassium foods*

Pleurisy root*

Potassium (low)

Potassium supplements*
Depletion or interference

None known
Supportive interaction

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Calcium
One controlled study showed that taking sotalol with a calcium gluconate solution dramatically reduces the absorption of the drug.1 Consequently, people who take a calcium supplement should take sotalol an hour before or two hours after the calcium.

Magnesium
Two individuals taking sotalol developed a side effect of the drug (a heart arrhythmia known as torsades de pointes) which was effectively treated with intravenous magnesium.2 3 Additional research is needed to determine whether people taking sotalol might be able to prevent this side effect by taking supplemental magnesium.

Potassium
People with prolonged diarrhea and vomiting, as well as those taking potassium-depleting diuretics, might develop low blood potassium levels. Individuals with low blood potassium levels who take sotalol have an increased risk of developing a serious heart arrhythmia and fainting. Therefore, people taking sotalol should have their blood potassium levels checked regularly and may need to supplement with potassium, especially when taking potassium-depleting diuretics.

Some beta-adrenergic blockers (called “nonselective” beta blockers) decrease the uptake of potassium from the blood into the cells,4 leading to excess potassium in the blood, a potentially dangerous condition known as hyperkalemia.5 People taking beta-blockers should therefore avoid taking potassium supplements, or eating large quantities of fruit (e.g., bananas), unless directed to do so by their doctor.

Interactions with Herbs

Pleurisy root
As pleurisy root and other plants in the Aesclepius genus contain cardiac glycosides, it is best to avoid use of pleurisy root with heart medications such as beta-blockers.6

Interactions with Foods and Other Compounds

Food
Taking sotalol with food gretly reduces the absorption of the drug.7 One study showed that taking sotalol with milk also decreases absorption.8 Therefore, sotalol should be taken an hour before or two hours after a meal or milk.

Antacids
Taking sotalol within two hours of antacids containing aluminum oxide and magnesium hydroxide dramatically reduces the absorption of the drug. Antacids that contain calcium carbonate might also reduce absorption.9 Consequently, if antacids are being used, sotalol should be taken one hour before or two hours after the antacids.

References

1. Kahela P, Anttila M, Tikkanen R, Sundquist H. Effect of food, food constituents and fluid volume on the bioavailability of sotalol. Acta Pharmacol Toxicol (Copenh) 1979;44:7–12.

2. Sasse M, Paul T, Bergmann P, Kallfelz HC. Sotalol associated torsades de pointes tachycardia in a 15-month-old child: successful therapy with magnesium aspartate. Pacing Clin Electrophysiol 1998;21:1164–6.

3. Arstall MA, Hii JT, Lehman RG, Horowitz JD. Sotalol-induced torsade de pointes: management with magnesium infusion. Postgrad Med J 1992;68:289–90.

4. Rosa RM, Silva P, Young JB, et al. Adrenergic modulation of extrarenal potassium disposal. N Engl J Med 1980;302:431–4.

5. Lundborg P. The effect of adrenergic blockade on potassium concentrations in different conditions. Acta Med Scand Suppl 1983;672:121–6 [review].

6. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press, 1996, 213–4.

7. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 741–5.

8. Kahela P, Anttila M, Tikkanen R, Sundquist H. Effect of food, food constituents and fluid volume on the bioavailability of sotalol. Acta Pharmacol Toxicol (Copenh) 1979;44:7–12.

9. Laer S, Neumann J, Scholz H. Interaction between sotalol and an antacid preparation. Br J Clin Pharmacol 1997;43:269–72.