From the Research
Sotalol dosing should be adjusted based on the patient's glomerular filtration rate (GFR), with a cutoff of 60 mL/min for normal renal function, 30-60 mL/min for moderate renal impairment, 10-30 mL/min for severe renal impairment, and avoidance of use in patients with GFR <10 mL/min.
Key Considerations
- For patients with normal renal function (GFR >60 mL/min), the standard dosing of sotalol can be used, typically starting at 80 mg twice daily with potential titration up to 160 mg twice daily 1.
- For patients with moderate renal impairment (GFR 30-60 mL/min), the dosing interval should be extended to every 24 hours rather than twice daily.
- For patients with severe renal impairment (GFR 10-30 mL/min), the dosing interval should be extended to every 36-48 hours.
- Sotalol is generally not recommended for patients with GFR <10 mL/min, as reduced renal function leads to drug accumulation, increasing the risk of QT prolongation and potentially fatal arrhythmias like Torsades de Pointes 2.
Monitoring and Safety
- Initial dosing should occur in a monitored setting with ECG assessment, particularly for patients with renal impairment, to ensure safety.
- Regular monitoring of renal function, electrolytes (especially potassium and magnesium), and ECG is essential during sotalol therapy 3.
Renal Function Assessment
- The estimated glomerular filtration rate (eGFR) can be used to guide dose adjustment in patients with stable kidney function, but its accuracy depends on various factors, including the formula used and patient characteristics 1, 4.
- The Cockcroft-Gault equation can be used to adjust medicine doses in patients with chronic renal impairment 3.