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Sotalol is a medication that should be used with caution and under specific circumstances. It is primarily prescribed for treating certain fast or irregular heartbeats, but it carries potential risks that require careful consideration and monitoring.

Key Safety Information and Warnings:

• Life-threatening Heart Rhythm Issues: Sotalol can lead to serious heart rhythm problems, including QT prolongation, which may result in a potentially fatal condition known as torsade de pointes. This risk is higher when initiating treatment or increasing the dose. It is crucial to start treatment in a hospital setting to monitor heart rhythm changes and manage any complications.

• Kidney Function and Dosing: Your doctor will start you on a low dose of sotalol and gradually increase it, depending on your response and kidney function. Regular monitoring through EKGs and heart checks is essential.

• Low Blood Pressure and Heart Rate: There is a possibility of significantly reduced blood pressure or heart rate, especially during the initial stages or dose adjustments. Staying hydrated and monitoring these vital signs at home is advised. Seek medical help if you experience dizziness, fainting, or severe fatigue.

• Heart Failure Risk: Sotalol may exacerbate or trigger heart failure. Contact your healthcare provider if you notice unexplained weight gain, swelling in the lower extremities, or increased difficulty in breathing, particularly when lying down.

• Breathing Difficulties: The medication can cause airway constriction leading to wheezing and coughing. Patients with a history of asthma or COPD should be closely monitored. Report any breathing issues to your provider immediately.

• Masked Hypoglycemia Symptoms: Sotalol can mask some symptoms of low blood sugar, except for sweating and dizziness. Diabetic patients should discuss blood sugar monitoring and medication adjustments with their healthcare provider.

• Discontinuation Risks: Do not abruptly stop taking sotalol, as this can lead to severe heart complications like chest pain or heart attacks. If discontinuation is necessary, your doctor will provide a plan to taper the dose over a period of 1 to 2 weeks.

• Severe Allergic Reactions: Although rare, some individuals may experience severe allergic reactions, including swelling, hives, or anaphylaxis. Immediate medical attention is required if symptoms such as difficulty breathing or swelling of the face occur.

Contraindications:

Sotalol should not be used if you have certain heart conditions (e.g., sinus bradycardia, sick sinus syndrome, specific types of AV block) without a pacemaker, congenital or acquired long QT syndrome, cardiogenic shock, severe heart failure, or if your blood potassium level is below 4 mEq/L. Those with asthma or significant respiratory issues should also avoid this medication. Always consult your healthcare provider if you have any of these conditions before starting sotalol.

By adhering to these guidelines and maintaining regular communication with your healthcare provider, the risks associated with sotalol can be effectively managed.

Common side effects:

• Tiredness
• Dizziness
• Slow heartbeat

Less common but important to monitor:

• Headaches
• Diarrhea
• Decrease in sexual ability
• Nausea
• Vomiting
• General weakness

Serious side effects:

• New or worsening symptoms of heart failure
• Shortness of breath
• Swelling in the ankles or feet
• Unusual tiredness
• Sudden weight gain
• Severe dizziness
• Fainting
• Sudden change in heartbeat
• Severe allergic reaction
• Rash
• Swelling of the face, tongue, or throat
• Difficulty breathing

Interactions with high risk of serious adverse effects and should be avoided:

• Fingolimod
• Bepridil
• Cisapride
• Dronedarone
• Grepafloxacin
• Levomethadyl
• Mesoridazine
• Pimozide
• Piperaquine
• Saquinavir
• Sparfloxacin
• Terfenadine
• Thioridazine
• Vernakalant
• Ziprasidone

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Amiodarone
• Disopyramide
• Dofetilide
• Clarithromycin
• Erythromycin
• Ibuprofen
• Naproxen