Abstract

CLINICAL PHARMACOLOGY OF SOTALOL IN INFANTS AND CHILDREN

Prof. Gian Maria Pacifici*

ABSTRACT

Sotalol is a nonselective β adrenergic receptor antagonist that prolongs cardiac action potentials by inhibiting delayed rectifier and possibly other K+ current. Sotalol is a racemate; the L-enantiomer is a much more potent β adrenergic receptor antagonist than the D-enantiomer. Sotalol prolongs action potential duration throughout the heart and QT interval, decreases automaticity, slows atrioventricular nodal conduction, and prolongs the atrioventricular refractoriness by blocking both K+ channels and β adrenergic receptors. In United States of America sotalol is approved to treat ventricular tachyarrhythmias, atrial fibrillation, and atrial flutter. Sotalol is not metabolized, does not bind to plasma protein, and the oral bioavailability of sotalol is good. In children, sotalol is used to treat life-threatening arrhythmias, life-threatening tachycardia, atrial flutter, ventricular tachyarrhythmias, ventricular arrhythmias, and supraventricular arrhythmias. The efficacy and safely of sotalol have been reviewed in infants and children. The pharmacokinetics of sotalol have been studied in newborns, infants, and children following sotalol oral dose of 10, 20, or 70 mg/m2 thrice-daily and the trough and peak concentrations and the area under the concentration-time curve of sotalol increase with the dose. The treatment of infants and children with sotalol has been reviewed. Sotalol freely crosses the human placenta and migrates into the breast-milk in significant amounts. The aim of this study is to review sotalol dosing, efficacy and safely, pharmacokinetics, and treatments in infants and children, and transfer of sotalol across the human placenta and migration of sotalol into the breast-milk.

Keywords: breast-milk, dosing, efficacy-safely, pharmacokinetics, placental-transfer, sotalol, and treatment.