Sotalol alternatives: What can I take instead of sotalol?

Compare sotalol alternatives | Pacerone | Multaq | Tikosyn | Flecainide | Rythmol SR | Natural alternatives | How to switch meds

Looking through the side effects list of antiarrhythmic drugs can sometimes be as frightening as the heart arrhythmias they aim to treat. Sotalol, the generic of brand-name Betapace, is a class 3 antiarrhythmic medication capable of preventing the disturbances of heart rhythm called atrial fibrillation, atrial flutter, and life-threatening ventricular arrhythmia. Paradoxically, sotalol can also provoke dangerous heart conditions, so it is certainly understandable if you are interested in knowing about other treatment options. Considering an alternative may also be worthwhile if sotalol is not working to prevent your heart arrhythmia. Whatever your reason for not being satisfied with the drug, we will review other options that you may want to talk to your healthcare provider about.

What can I take in place of sotalol?

Even if sotalol is not going to work out for you, other class 3 antiarrhythmic medications could still be useful. Most members of this antiarrhythmic class help to prevent abnormal heart rhythm issues by blocking potassium channels in the heart, which slows aspects of electrical conduction. Certain members have other actions which could make for a better match with you. Alternatively, class 1 antiarrhythmics can oftentimes be used for similar conditions, but their mechanism is to interact with sodium channels in the heart in order to alter conduction. The different mechanisms may be preferable for some who are aiming for rhythm control in the treatment of atrial fibrillation.

Atrial fibrillation (AFib) is a heart rhythm disorder that can be easier to control than to prevent. In other words, an individual could remain in atrial fibrillation and feel fine as long as their heart is not beating too fast. If controlling your heart rate is the goal rather than preventing the arrhythmia, then beta blockers and digoxin (class 2 antiarrhythmics) can accomplish this by inhibiting beta adrenergic receptors in the nerves that supply the heart. These agents can go even too far and cause bradycardia, an abnormally slow heart rate. Sotalol actually has some beta blocking activity too. Besides beta blockers, heart rate control can be obtained by using calcium channel blocker drugs (class 4 antiarrhythmics). 

Top 5 sotalol alternatives

1. Pacerone (amiodarone)

Pacerone is a class 3 antiarrhythmic medication with complex mechanisms, including both potassium and sodium channel blockage, along with both beta blocking and calcium channel blocking ability. It can be effective for arrhythmias that originate in the atria (top chambers of the heart) or ventricles (bottom chambers). If sotalol has not been meeting the goal of keeping your heart from going into an atrial fibrillation rhythm, Pacerone might be a better option. A clinical trial in individuals with structurally normal hearts who had a history of AFib found amiodarone to be more effective than sotalol in keeping them from having AFib recurrences. Amiodarone is also a first-line option for AFib prevention for those with structurally abnormal hearts. As a bonus, low-dose amiodarone has a relatively low incidence of torsade de pointes, a life-threatening arrhythmia that can occur as a side effect of antiarrhythmic drugs. 

The news is not all good about this medical option, however. Pacerone has quite a list of significant adverse effects that it can cause. Thyroid dysfunction, lung and liver toxicity, neurologic complications, heart rate or rhythm abnormalities, and eye problems are a few of the important ones to watch out for. Monitoring for side effects is often advised. Catching any of these issues early can be important because amiodarone has such a long half-life, extending to 100 days in some cases before the bodily concentration drops in half after stopping the drug . 

2. Multaq (dronedarone)

Another class 3 antiarrhythmic Multaq happens to be a derivative of amiodarone. It can be used to prevent recurrences of Afib or atrial flutter. Multaq’s advantages over sotalol include a preferred status in those with left ventricular hypertrophy, which is muscle enlargement of the main pumping chamber of the heart. It also has sotalol beat in terms of initial convenience. Sotalol is typically begun in the hospital in order to monitor for slow heart rates, QT interval prolongation (a cardiac conduction abnormality), and provoked arrhythmias. Multaq, on the other hand, can more readily be started as an outpatient.

Convenience does not make Multaq the right choice for everyone. If you have moderate to severe heart failure or need to prevent ventricular arrhythmias, you should probably keep looking for other options.

3. Tikosyn (dofetilide)

You may be interested in Tikosyn based on effectiveness. A study directly comparing sotalol and Tikosyn found Tikosyn to be more effective for the prevention of AFib recurrence. The two class 3 antiarrhythmic drugs have some similar positive and negative attributes. They can both be used in the setting of structural heart disease, heart failure, and coronary artery disease. Both require dose adjustments in the setting of renal impairment (kidney disease). Unfortunately, like sotalol, Tikosyn typically requires admission to the hospital when started. Monitoring in this environment is done to look out for serious heart rhythm side effects. 

4. Flecainide

Flecainide might provide you with an effective option that can be started without having to stay in the hospital. It is a class 1 antiarrhythmic with indications for a variety of heart rhythm abnormalities. While it can be initiated without hospital-based monitoring in some circumstances, flecainide still has the potential to cause life-threatening arrhythmias. In fact, the drug was found to be associated with an adverse effect on mortality in those with coronary artery disease (particularly after a heart attack), heart failure, and structural heart disease.

5. Rythmol SR (propafenone sustained release)

Rythmol SR is another class 1 antiarrhythmic with recommendations against use in the setting of coronary artery disease, heart failure, and structural heart disease. If these limitations do not apply to you, Rythmol SR could represent a reasonable alternative to sotalol. Be forewarned, however that 15-20% of people stop Rythmol due to its most common side effects, particularly cardiovascular problems, gastrointestinal symptoms like nausea and taste disturbance, and neurologic symptoms such as dizziness and blurred vision.

Natural alternatives to sotalol

The adverse effects of antiarrhythmic medications are substantial, and no doubt, you want to know if there are options that do not require one of these drugs. Supplements are usually of interest, but they have to be vetted by your healthcare provider. Illustrating the need for caution, omega-3 fatty acids found in fish oil supplements were associated with an increased risk of atrial fibrillation. You can still make helpful dietary changes. Reducing alcohol, lowering blood pressure, cutting back on salt, stopping smoking, and losing weight could all prove beneficial for your cardiovascular health. 

How to switch to a sotalol alternative

Heart rhythm abnormalities can be life-threatening, so you must be careful in your approach to treatment. Sotalol may not be meeting your needs or could be causing side effects. Nonetheless, any decisions about your treatment must be made in concert with your cardiologist or other qualified healthcare provider. Call your provider, talk about your concerns regarding sotalol, and ask for their medical advice on possible alternatives. You can prepare for the conversation by having a list of your prescription drugs and over-the-counter medications, in order to look for any potential drug interactions. Together, the two of you can reach the best decision.