Betapace (Sotalol)

Description

Betapace is a medicine used to help control irregular heartbeats, known as arrhythmias. It works by calming the heart and blocking some electrical signals that can cause the heart to beat too fast or in an unusual way. Doctors may give this medicine to people with conditions like atrial fibrillation (AFib) or serious heart rhythm problems. Sotalol comes as a tablet and is usually part of a broader plan to treat heart rhythm problems.

Directions

Betapace is taken by mouth, following the prescription label's instructions carefully. Patients typically initiate treatment at a standard dosage of 80 mg, administered twice daily. The dosage can then be increased in increments of 80 mg per day every 3 days until a maximum dosage of 320 mg per day is reached. It's important to take Betapace at consistent times every day to maintain an even level of the medication in your bloodstream. Consult a healthcare provider for concerns about the appropriate dosage.

Ingredients

The active ingredient in Betapace is sotalol.

Contraindications

Avoid taking Betapace if any of the following apply:

• Known hypersensitivity to sotalol or any of its components
• Individuals with a baseline QT interval above 450 milliseconds
• Patients with bradycardia, causing a heartbeat slower than normal
• Those with heart block without a functioning artificial pacemaker
• Individuals who have cardiogenic shock, a condition where the heart fails to supply enough blood to the body
• Patients with uncontrolled heart failure
• People with a history of asthma or other bronchospastic conditions
• Those diagnosed with sick sinus syndrome without an artificial pacemaker
• Individuals with serum potassium less than 4 mEq/L

Cautions

• Before taking Betapace, you may want to consult a healthcare provider about the following:
• Any existing health conditions
• Any allergies
• A list of all medications you are currently taking
• Whether you are pregnant or breastfeeding

• Betapace can cause serious and sometimes life-threatening heart rhythm problems, especially a condition called Torsade de Pointes—a type of dangerous, fast, and irregular heartbeat. Your risk is higher if you have kidney problems, low heart rate, heart failure, or low levels of potassium or magnesium.
• Betapace may severely slow down your heartbeat. This can lead to dizziness, fatigue, or even pauses in your heartbeat. The drug is not recommended for people with conditions like sick sinus syndrome or certain types of heart block.
• Betapace may lower your blood pressure too much, especially if your heart function is already weak. Let your doctor know if you feel faint, lightheaded, or weak during treatment.
• In some cases, Betapace may make heart failure worse, especially when starting or increasing the dose. Watch for signs like swelling, shortness of breath, or sudden weight gain, and notify your doctor right away if these occur.
• If you’ve been taking Betapace regularly, don’t stop it suddenly without medical advice. Stopping abruptly can increase your risk of chest pain, heart attack, or other heart problems—especially if you have heart disease.
• People with lung diseases like asthma, chronic bronchitis, or emphysema may have trouble breathing while taking Betapace. If this medicine is necessary, it should be used at the lowest possible dose, and you should be monitored closely.
• Betapace may hide the warning signs of low blood sugar—like a fast heartbeat—making it harder to know when your blood sugar is dropping. It can also increase the risk of low or high blood sugar, especially in people with diabetes or those who aren’t eating normally.
• If you have thyroid disease, don’t stop Betapace suddenly—it could trigger symptoms of an overactive thyroid, including a life-threatening condition called thyroid storm. Also, Betapace can hide common symptoms like a racing heart.
• If you’ve ever had a serious allergic reaction, be aware that Betapace might make future reactions more intense. It may also reduce how well epinephrine works during treatment of severe allergic responses.
• Don’t stop Betapace before surgery unless your doctor says it’s safe. During surgery, this medicine can affect how your heart responds to anesthesia and stress, so your care team needs to know you’re taking it.

Side Effects

The most common side effects of Betapace include fatigue, dizziness, headache, nausea, and shortness of breath. These effects are generally dose-related and tied to the drug’s beta-blocking and antiarrhythmic actions. In clinical trials, up to 20% of patients reported fatigue, and bradycardia occurred in 12–13% of patients, particularly at higher doses. Dizziness and gastrointestinal problems such as diarrhea and vomiting were also observed more frequently in Betapace-treated groups than placebo.

Betapace can cause serious and potentially life-threatening arrhythmias, especially Torsade de Pointes, a dangerous form of ventricular tachycardia. The risk increases with higher doses and prolonged QT intervals. Discontinuation due to side effects was needed in about 17% of patients, most commonly for fatigue, slow heart rate, or worsening rhythm abnormalities. Post-marketing reports have also included rare reactions such as mood changes, photosensitivity, pulmonary edema, blood cell disorders, and hair loss.

References

1. Betapace (Sotalol) Product Monograph. Zug, Switzerland: Covis Pharma; 2023.
2. Betapace (Sotalol) Drug Label Information. Zug, Switzerland: Covis Pharma; 2023.

About Dr. Gerardo Sison (Page Author)

An honors graduate of the University of Florida, Dr. Sison started his pharmacy career in a community setting, extending his services to hospitals and clinics over time. He has also worked in medication therapy management, advising patients on proper medication use for their chronic health conditions. Read More....