Sotalol (Betapace) to Control Heart Rhythm

Unless otherwise noted, the following information about sotalol (Betapace AF®) comes from the package insert.1


Sotalol is an antiarrhythmic drug for maintaining normal sinus rhythm in those with symptomatic afib or atrial flutter who are in normal sinus rhythm already. The goal is to prolong the time spent in normal sinus rhythm, although the afib can recur.

How to Use

Hospitalization for three days is required to start sotalol. Sotalol is taken by mouth. Your doctor will determine the correct dose for you.


Sotalol can cause serious ventricular arrhythmias (when the heart beats too fast and can’t pump enough blood). Thus, sotalol should not be used for those with:

  • Certain cardiovascular conditions
  • Asthma
  • Low potassium levels
  • Kidney disease

Common Side Effects

These are common side effects of sotalol.

  • Bradycardia, or a slower than normal heartbeat
  • Nausea and vomiting
  • Fatigue
  • Dizziness

Serious Side Effects

Contact your doctor immediately if you experience any of these serious side effects.

  • Excessive or prolonged diarrhea
  • Sweating
  • Vomiting
  • Loss of appetite or thirst

Drug Interactions

Talk with your doctor if you are taking these medications that can interfere with sotalol.  

  • Certain drugs that can affect heart rhythm, such as other antiarrhythmics
  • Some tricyclic antidepressants
  • Phenothiazines, which are used to treat schizophrenia and other psychotic disorders
  • Certain oral macrolides, which are used to treat bacterial infections


The various guidelines have specific recommendations related to sotalol.

  • US guidelines (AHA/ACC/HRS) recommend sotalol for maintaining sinus rhythm in afib patients depending upon underlying heart disease and other health conditions.2
  • European guidelines (ESC) suggest that sotalol may be considered for long-term rhythm control with close monitoring in patients with normal left ventricular function or with ischemic heart disease, caused when the arteries to your heart are narrowed, so less oxygen reaches the heart.3
  • Canadian guidelines (CCS) leave the choice of which anti-arrhythmic to use for maintaining rhythm control up to the physician based on patient characteristics. 4