The usual dosage range for sotalol is 80 - 160 mg for an adult. The dosing frequency is bid with normal renal function and qd for mild reductions in renal function.
Renal function should be evaluated regularly.
(1) If there is a deterioration of renal function and the patient is taking sotalol bid, then the dosing frequency should be reduced from bid to qd.
(2) If there is a deterioration of renal function and the person is taking the drug qd, then reduce the daily dose.
(3) If the creatinine clearance is < 40 mL/min, then the drug should be discontinued.
(4) If renal function improves and the person is taking the drug qd, then the dosing frequency can be changed from qd to bid dosing.
Monitor the QT interval when there is a change in dosing:
(1) Monitor the QT for 2-4 hours after each dose. Discontinue an infusion if QT > 500 msec during initial dosing.
(2) The person should be monitored for at least 3 days after dosing changes (up to 6 days on QD schedule).
Monitor the QT interval periodically while receiving the drug:
(1) If QT >= 520 msec (or JT >= 430 msec with QRS > 100 msec) then the dose should be reduced and the patient monitored until the QT drops below 520 msec.
(2) If the QT >= 520 msec while on 80 mg bid (or 80 mg qd with reduced creatinine clearance) then the drug should be discontinued.
