if sotalol makes one too tired, do they change the dose

I feel like I am getting more tired more often the longer I am on sotalol. Have been on it 7 weeks now, 80 mg BID. Do you think I should try to contact cardiologist to get it lowered? My ablation is said to probably take place with Natale in August, still waiting for exact date.

Thanks.

Sure, why not?

You know sotalol isn't a life saving drug for you, right? The worst that will happen from reducing or even stopping it is you'll have more afib episodes. So you don't need anybody's permission to reduce your dosage or even stop it altogether. But it probably would be a good idea to get your cardiologist on board and write a new prescription for you. Maybe 40 mg bid instead? The stuff sucked the life out of me too.

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Carey
Sure, why not?

You know sotalol isn't a life saving drug for you, right? The worst that will happen from reducing or even stopping it is you'll have more afib episodes. So you don't need anybody's permission to reduce your dosage or even stop it altogether. But it probably would be a good idea to get your cardiologist on board and write a new prescription for you. Maybe 40 mg bid instead? The stuff sucked the life out of me too.

Carey,

You may remember my cardiologist is out of town on leave now until August (5 mo) because of a family medical issue. Last week they rescheduled my appointment & they told me he had 900 patients needing rescheduling. His assistant is handling things while he is out as they are in touch daily I think. I can ask her to ask him about me lowering the med & getting a new script, but not sure how that will go. I wonder if he okays it if I could halve the 80-mg pills & take half in am & half in pm so I can finish out this script.

I do want to ask you about sotalol. When I was on carvedilol (Coreg), I had to titrate off carefully over a period of weeks or there was threat of heart attack or at least heart disturbances if one did not come off of it properly. Are you now saying sotalol (being an antiarrhythmic though it has some beta blocker properties if I understand correctly) does not need careful titration off? Also since reconnecting with this cardiologist, I promised to remain steady on what they prescribed, not changing doses around on my own. So, I am not knowledgeable about sotalol like I was about carvedilol (as I was given instructions by EP on how to get off carvedilol) & with my ablation looming & Dr. Natale's staff having my list of medications, I did not know if it was advisable to experiment now either with or without their help. But this time around, I would want their okay first because of what this cardiologist told me & because of ablation coming up. After all, I do have 2 1/2 months before ablation if it is indeed scheduled for August.

Can you answer some of my questions here again? Thanks.

When I was put on Sotalol in 2016 by my local Cardiologist, I was actually put in the Hospital to get my dosage right. I cannot say why this was done but my Cardiologist would not do it any other way. I was in the Hospital 3 days. I could not take Multaq because my Insurance would not pay for it.

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smackman
When I was put on Sotalol in 2016 by my local Cardiologist, I was actually put in the Hospital to get my dosage right. I cannot say why this was done but my Cardiologist would not do it any other way. I was in the Hospital 3 days. I could not take Multaq because my Insurance would not pay for it.

I was in the hospital when they started it as well. Started it 10 pm one night & 10 am next day & released me a few hrs after another ekg confirmed ok. I do not know how they feel about changing dose, but I have contacted his assistant who will be in touch with him to see about it.

You don't need to taper off sotalol. In fact, you only need to taper off any type of beta blocker if you've been on it for years, or at least many months. I've stopped it several times with no tapering.

Are the tablets scored? If so, you can cut them in half. If they're not scored, check with a pharmacist but I'm 99% sure you can. That's what I would do if I were in your shoes. If you end up in afib, just go back to the 80 mg dose.

I agree with the advice given here. If the Sotalol is wiping you out, then the dose is too high, and if I was in this spot, I would cut the dose down to 40mg BID on my own.

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Carey
Are the tablets scored? If so, you can cut them in half. If they're not scored, check with a pharmacist but I'm 99% sure you can. That's what I would do if I were in your shoes. If you end up in afib, just go back to the 80 mg dose.

Yes, they are scored & I cut in half & will take 40 mg starting tonight. I was wiped out today after a long walk. I did get a Pilates class in the morning too. Tired of no sustained energy, needing to lie down & rest & being exhausted feeling. I doubt if I had not already had the discipline to exercise daily that I would be doing much of anything, but my habits are there despite my energy, thank goodness!

Carey, et al - I did cut my pill in half & Monday night took 40 mg & Tues took 40 BID & today have had 40 so far. Maybe it is my imagination, but I felt better immediately. I slept much better the past 2 nights & I do not feel sluggish & tired. I have not had a reply from my cardiologist yet about decreasing, but regardless of what he says, I am sticking with this & just won't say anything about it yet if his reply differs. With the ablation coming up hopefully in August, does it matter that much if I decrease? Don't they ask you to stop the meds right before the ablation anyway? My doctor may not even be back in the office until August as well.

Oh, on another thought, I want to ask about proper terminology and understanding of just what it is I do have. What I mean is - when discussing what I have with someone, do I have heart disease just because I have atrial fibrillation even though I have no structural abnormalities as some with afib do? And, I do not have cholesterol problems & am not overweight & do not have the apple-shaped body which puts one at more risk of heart disease & stroke. Who knew there was so much variability in heart problems! I read in Hans' book that some think my kind of afib is more of an autonomic nervous system disorder manifested through the heart. So when asked, do I say yes I have heart disease or do I say my heart is fine, I just have an electrical disturbance & I will be having a procedure to hopefully take care of that. It is not a disease. The procedure is not really considered heart surgery either, though when I start to say I am going to have a procedure done on my heart, it sounds like heart surgery at first. I think anything done on the heart is serious though.

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Madeline
With the ablation coming up hopefully in August, does it matter that much if I decrease? Don't they ask you to stop the meds right before the ablation anyway?

It doesn't matter to the ablation at all. You'll be told to stop the sotalol several days prior to the ablation, probably three or four. Glad cutting the dosage down worked for you, and I think you're exactly right to just continue the lower dosage no matter what your cardiologist thinks.

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Oh, on another thought, I want to ask about proper terminology and understanding of just what it is I do have. What I mean is - when discussing what I have with someone, do I have heart disease just because I have atrial fibrillation even though I have no structural abnormalities as some with afib do?

If asked if you have heart disease your answer should be no. Although the thinking on this is changing and afib is coming to be viewed as a form of heart disease, at this point everyone, including cardiologists, would misinterpret a yes answer as meaning you have more than afib, so don't say that.

Ditto what Carey said regarding heart disease. Just say no. If you say yes, 99% of medical professionals will assume you mean blocked coronary arteries, cardiomyopathy, and/or valve replacements.

Hi Madeline,

I only take a quarter, sometimes a half of the 80mg sotalol... and then, only if I observer myself to be at risk of AF trigger. I have paroxysmal, so if i'm low on sleep, or approaching a potentially emotional or confrontational or adrenal-kick event that day, I'll take a half of the sotalol. Seems to work, tho sometimes i wonder if there isn't a bit of placebo effect. May i ask how long you've been in AF? and your age? Thanks. I'm 48, with Lone AF for 18 years.