Comparison of a standard versus accelerated dosing regimen for D,L-sotalol for the treatment of atrial and ventricular dysrhythmias.
BACKGROUND
The current recommended starting dose of sotalol is 80 mg orally twice per day, followed by a judicious increase in dosage every 3 days under continuous telemetry monitoring. We hypothesized that sotalol administered at a higher starting dose (120 or 160 mg twice daily) would allow a more rapid attainment of therapeutic response with an acceptable safety and comparable efficacy profile.


METHODS
Two hundred nine inpatients with various atrial and ventricular dysrhythmias were begun on either a standard starting dose (80 mg b.i.d.) or an accelerated dose (120 or 160 mg b.i.d.) of sotalol. In-hospital occurrences of drug-related adverse effects (proarrhythmic and others), drug efficacy, and length of hospitalization were retrospectively compared between the two groups.


RESULTS
Ten patients (9.3%) in the 80 mg b.i.d. starting dose group experienced a cardiac adverse effect of sotalol as compared to 15 patients (14.9%) in the accelerated dose group (P = 0.286). The mean amount of corrected QT (QTc) prolongation over baseline was not significantly different between the two groups at hospital discharge (22.5 ms vs 21.6 ms, P = 0.898). There was a trend toward more noncardiac side effects of sotalol in the accelerated dose group: 2 (1.9%) versus 7(6.9%), P = 0.092. The average length of hospital stay was similar in the two groups (6.8 days vs 7.4 days, P = 0.558).


CONCLUSIONS
Initiating sotalol at 120-160 mg orally twice per day marginally increases the risk of cardiac and non-cardiac side effects compared to the standard starting regimen of 80 mg b.i.d. Such an accelerated dosing regimen neither shortened hospitalization nor had any effect on treatment efficacy in this retrospective analysis.
Kim
Robert J
RJ
Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. Robert.J.Kim@Hitchcock.org
Juriansz
G Jeremy
GJ
Jones
D Randy
DR
Gerling
Barbara R
BR
Holzberger
Peter T
PT
Greenberg
Mark L
ML
D000284:Administration, Oral; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013015:Sotalol / Q000008:administration & dosage*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*
D000889:Anti-Arrhythmia Agents; D013015:Sotalol