Sotalol or Propafenone experiences?

Hospital started sotalol last night. I just had an ekg 10 hours later.

Anyone tried it? Experiences? Were you successful in remaining in nsr? It dropped my hr to 54. That’s the only symptom I have.

I read up on its ventricular risks and how one needs constant monitoring with a hospital facility recommended with crash cart opposed to initiating at home. I had a flecainide overdose and Multaq caused high liver test scores so it was discouraged. It also didn’t help.

My other choice they mentioned is Propafenone which I think is the same class as flecainide which I can never take again.

Anyone have experienced Propafenone?
Did any of you had to be admitted 2-3 days to initiate solotol and get ekgs to find the right dose? What dose are you on? I’m told it’s not weight dependent. I was told 80mg 2/day is usually the dose for a beta blocker and a starter dose but 120mg twice a day is more successful for AF. Every is different but there are standard dosing for specific uses.



Edited 1 time(s). Last edit at 12/29/2020 09:33PM by susan.d.

Sotalol at only 40mg wiped me out for about an hour or so, I had trouble staying awake to drive, felt like passing out. 80mg x2 daily is the normal starting dose, never again.

Susan:

I took Propafenone for a number of years, i took it at night before going to bed, i took 150,mg., I took it before bed because I was Vagal and got my episodes during the night. i never had any problems with it, maybe it was because when i took it i went to bed. it stopped being helpful in stopping my AF a year ago when I went into permanent AF. I often wondered if it helped me at all because i took it before bed and yet I always got AF usually around 5:00 in the A.m. , I always was able to go back into NSR in previous years, but taking it before bed if Propafenone was so good why did I get AF at all. It might help you Susan and it doesn't seem to cause any problems.

I had my ablation on December 15th and was placed on sotalol 80 mg twice a day. So far so good. I remain in NSR. I expressed my concerns to dr. Natale but he said that at the low dose it would not be a problem. So far that has been the case. Everyone's different but that is my experience.

Thank you everyone. Frank and Anti-fib—did you have to be in a hospital setting during initiating the drug to have ekgs 2-4 hours after each dose to check for prolonged QT? I’m asking because of covid19, my hospital floor was shrinking and replaced with first two then three covid19 wards. The hospitalist thought it was safer to discharge me and continue as an outpatient with the ekg monitoring.

I was put on sotalol twice. No hospitalization required either time. Most EPs only require starting it in the hospital if you already have a somewhat widened QT interval or you've shown a tendency toward it in the past.

If they do require hospitalization, they won't be doing ECGs every 2-4 hours. That's a practice that predates continuous monitoring, which is what they use these days. You'll be free to get up and wander anywhere you want as long as you remain within range of the wifi.

Sue, the sotalol was started after I left the hospital.
But unfortunately I spoke too soon yesterday as I went into afib at about 5am this morning. It's now 2 p.m. and I'm still in AFib. Very discouraging but I understand that this happens during the blanking period and does not mean failure. Good luck to you.

Frank, I hope you convert soon. What did your NP say?

Carey, thanks for your posting - I didn’t mean an ekg every 2-4 hours, that’s overkill—just after each dose when they are ramping you up from 80 to 120mg twice a day and the initial 80 doses. Drugs.Com recommended 2-3 day hospital stay when starting the drug. I was wearing a telemetry monitor the entire time to check for af/flutter/SVT. The ekgs were just for seeing if I got prolonged qt from the drug. K labs to see if my potassium was low (it was) while on the drug. I’m doing this as an outpatient now. Medicare pays for a phlebotomy to come to my house and my np office visit tomorrow for an ekg.

I am going to stay on 80 and hope it works. Maybe it will because I’m petite.

Carey- betapace has a long half life. Did you have to wean off slowly or stop earlier for your last ablation to rid it out of your system? Or is it like flecainide or multaq where you can stop cold turkey?

i had an appt. with my EP today but because of the bad weather we had i couldn't go (it is about an hours drive), so they set up a Phone conference with me. I spoke about some anti-arrhythmic drugs that might help me and the only drug he believes might help would be Tikosyn along with a cardioversion. I asked about Flec. he didn't think it would really help, so it is something I might think about for later on after this Pendemic lessens. Those docs at U of M just think Tikosyn is the best drug for AF. I know that some of you have taken it (Carey) and others have taken Flec., so that is that. Happy New Year.

Two cardiologists this week in the hospital said (for their protocol may not be your EPs protocol) that it’s a 5-7 hospital stay when starting Tikosyn. Liz, do you feel comfortable being in the hospital right now?

Quote
susan.d
Carey- betapace has a long half life. Did you have to wean off slowly or stop earlier for your last ablation to rid it out of your system?

I just stopped it. I wasn't on it long enough to require weaning. Sotalol (Betapace) is a beta blocker and behaves like all the other beta blockers, so weaning is usually only necessary if you've been on it for quite some time (years or at least many months).

Twelve hours isn't really all that long of a half-life. Most EPs will want it out of your system before an ablation, so with its 12-hour half-life that means stopping it 3 days before the procedure. Picky docs might want 5 days, but either way it's not a long time.

I had my ablation on December 15th. I was put on 80 mg of sotalol b i d. I was not on an antiarrhythmic prior to my ablation. I was in NSR up until early this morning. I have now been in AFib for about 12 hours. Is this usual during the blanking period? Is 12 hours too long? My nurse practitioner is not in the office and the one covering asked for my heart rate and blood pressure which I was able to provide her with. Blood pressure was 123 over 92 and heart rate was 111. She asked me to self monitor and hope to self convert to NSR and to call back if the situation got worse. Is this type of scenario common for the blanking period? I am nervous about being on sotalol and would be reluctant to raise the dosage if recommended. I also wonder if an antiarrhythmic is really needed during the blanking period. I wonder if a beta blocker like metoprolol can be used if the rate gets too high. I would appreciate input into any of these issues. Thanks.

I'm still new at posting on this site. My previous post was meant to start a new topic. Please view it that way

Quote
susan.d
Two cardiologists this week in the hospital said (for their protocol may not be your EPs protocol) that it’s a 5-7 hospital stay when starting Tikosyn. Liz, do you feel comfortable being in the hospital right now?

That’s a rather lengthy stay. It should be more like 3 days.

Quote
wolfpack

Two cardiologists this week in the hospital said (for their protocol may not be your EPs protocol) that it’s a 5-7 hospital stay when starting Tikosyn. Liz, do you feel comfortable being in the hospital right now?

That’s a rather lengthy stay. It should be more like 3 days.

As I said, it is their protocol that could differ from your EP protocol.

Susan;

Its a 3 day stay in the hospital I am told. But, I wouldn't do it now anyway, not with Covid going ballistic, perhaps in the spring, i don't like hospitals and would rather try Flec..

Liz- flecainide worked successfully for me for 5 years straight then I threw up and triggered AF, then 3 years of straight nsr until a chemo IV then 2 years free until I threw up again then yearly for a few years always on January 1st and then less until it became unsuccessful in 2019. I had a successful long run from 2004. I hope you are as successful.

Quote
susan.d
As I said, it is their protocol that could differ from your EP protocol.

Three days is an established guideline, not just some doc's protocol. I've never heard of anyone spending 5-7 days in the hospital starting Tikosyn and I've known quite a few people who've done so (including me). Even just the three days I spent cost my insurance company over $12K, so I suspect the insurance company will balk at 5-7 days unless the doctor can provide justification.

Carey- as I said, it is my local EP’s protocol and he has been an EP for decades. In the hospital a cardiologist visited me and mentioned 5 day Tikosyn monitoring. I think everyone has their own protocol. I’m aware drugs.com recommends 3 days for Tikosyn and Sotalol is also a 3 day recommendation (drugs.com). See below. A recommended ekg after 2-4 hours of dosing is recommended.:

“ SOTALOL: (ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIA):
-Initial dose: 80 mg orally 2 times a day
-Doses should be adjusted gradually every 3 days in order to attain steady state plasma concentrations and allow for monitoring of QT intervals.
-Maintenance dose: The initial dose may be increased, if needed, to 240 or 320 mg orally per day (120 to 160 mg orally 2 times a day).
-Some patients with life-threatening refractory ventricular arrhythmias may require 480 to 640 mg per day in divided doses.
Comment:
-Because of the long terminal elimination half-life of this drug, dosing on more than a twice a day regimen is usually not necessary.

ORAL [BETAPACE AF (R)}: (ATRIAL FIBRILLATION):
-(STEP 1) Electrocardiographic assessment: Prior to administration of the first dose, the CrCl and the QT interval should be determined. If the baseline QT is greater than 450 msec, Betapace AF (R) is contraindicated:
-(STEP 2): Calculate the CrCl for the patient.
-(STEP 3):
Initial dose:
-If the CrCl is less than 40 mL/day: Betapace AF (R) is contraindicated
-If the CrCl is 40 to 60 mL/min: 80 mg once a day
-If the CrCl is greater than 60 mL/min: 80 mg orally 2 times a day
-(STEP 4): Continuous ECG monitoring with QT interval measurements should begin after the first dose and every 2 to 4 hours after each additional dose.
-(STEP 5); If the 80 mg dose level is tolerated and the QT interval remains less than 500 msec after at least 3 days (after 5 or 6 doses if patient receiving once-daily dosing), the patient can be discharged.”

I'm just telling you what happens in the real world. You're taking stuff you find online literally, when quite often the stuff you find on drug dosing and usage is what was originally approved by the FDA years ago. Read up on flecainide for a good example. By the same token, the original guidelines often get changed with clinical experience over the years. Again, look at flecainide. It's not even approved for use with AF but it's probably the most common antiarrhythmic drug used to treat AF. So all I'm saying is your EP's 5-day initiation for Tikosyn is extremely unusual and not within the established guideline of 3 days. Almost all EPs would consider 5 days unnecessarily long. Personally, I'd walk out of the hospital after 3 days if there was no QT widening.

I posted sotalol protocol drug dosing you replied to. Tikosyn I did mention drugs.com recommended 3 days of hospital stay but some medical professionals may want longer from 5-7 days based on patient to patient histories. It’s not carved in stone.

Just to ask your first question...
Here's my experience with those drugs.

- First afib episode : self converted without drugs 14h later.i
- 2nd episode : went to the ER where they gave me IV amiodarone. Then, after a TEE, they performed an ECV. So, back to NSR about... 14h after the onset of afib. They sent me home with propafenone.
- 2 afib episodes while taking propafenone. They were shorter (about 5h). Couldn't take a higher dose, for the 'normal' one was already too high for me (QRS enlargement).
- Switched to sotalol. Still a couple afib episodes/month, about 20h each. Couldn't increase the dose of sotalol, too disabling for me (and HR below 50 at rest).
- First ablation. Still afib, even with sotalol. Thousands of ectopics while not in afib. Sotalol was killing me.
- Switched to flecainide and bisoprolol. Much less ectopics, but still afib from time to time. Couldn't take more than 100 mg flec/day because of QRS enlargement.
- Tried flecainide as PIP. Useless.
- Got three more ablations. Still about 1h afib/week. Always self convert without any drug, so, I'm living with that...

Of course, it's me and, as usually said, we're all different, but I think all those rhythm drugs are really dangerous. If possible, I'd favour ablation over those drugs.
I'm not sure I wouldn't go for a fifth procedure.

Healthy new year !

Quote
Pompon
Couldn't increase the dose of sotalol, too disabling for me (and HR below 50 at rest).
Healthy new year !

Thanks Pompon
I am at the starter dose of 80mg 2/day and my resting hr is 47-48 and high 50s when active. I’m not concerned about my hr but I am completely tired out and have a stomach ache/bathroom and gaining weight. Small price if I can remain in nsr and avoid the ER with >200 hr. I do however miss Tenormin because sotalol is not protecting me from violent PVCs. Tenormin stops them in their tracks but I can’t be on both BB. I’ve been on Tenormin since 1987 so I am having the same withdrawals as before.

I just want to clarify that I am described by two EPs as being a complicated case since my flecainide overdose. I am fragile and must be treated more cautiously than the general population. That said, their drug protocol was custom changed for me and does not reflect the general hospital stay protocol for QT monitoring, drug dosing or medical care that other stronger patients or general practice care dictates.



Edited 1 time(s). Last edit at 01/03/2021 02:44PM by susan.d.

I was started on Sotalol 80mg 2x daily, only was in nsr for about 10 days. Increased to 120mg, only lasted 5 days. Went to 160mg 2x daily 2wks before my ablation on Jul 27, 2020. Was in NSR until 9/17 when EP had me stop to see if ablation would allow me to stop taking. Episode lasted about 30hrs, went to ER after 20hrs and they started cardizem drip. Converted about 6hrs later and went back on the 160mg x2 Sotalol and have been in NSR ever since. EP wants me to lower dose to 120mg to see how I do, but waiting for our hospitals to thin out just in case I need to go in. I’m 49, I do notice some fatigue with this dose, but will take that over being in a-fib. I was started on the med outside of hospital and went for ekg 3 days after starting. My sister is 60 and she has been on the 80mg dose for 2yrs with no a-fib or ill effects.

Kathy, good news and positive support that your sister is successful on sotalol. I hope you too get relief.

As I had posted, everyone is different. I felt better on two chemos, one a cardio risk [Herceptin- [www.breastcancer.org] [www.breastcancer.org] ] than my 80 mg Sotalol twice a day. I have a complex case and am totally knocked out while on Sotalol which wears me out so much worst than I had experienced after 4 hours of IV chemo drips. But that’s one isolated case not to be confused to others taking this drug and having no side effects. However if you ever had Herceptin or/and a flecainide overdose, it may be worth reading the links above and past posts of the dangers of taking 300mg PIP flecainide if you weigh less than 154 pounds if you experience side effects not typically for the general population.



Edited 1 time(s). Last edit at 01/04/2021 04:40PM by susan.d.

Quote
The Anti-Fib
Sotalol at only 40mg wiped me out for about an hour or so, I had trouble staying awake to drive, felt like passing out. 80mg x2 daily is the normal starting dose, never again.

You were lucky it passed after an hour. I’m wiped out all day with 80mg 2/day Sotalol. I’m an unique case —but still it’s so difficult. When compared to two simultaneous treatments of chemo drips-Sotalol is way worst. I used to hop on a plane the day after a double chemo and travel 22 hours with connecting flights to visit my grandkids abroad and I felt good. Now with Sotalol I’m planted on my couch feeling it would take a fire or a home invasion to motivate me to move. But hey, I’m in nsr so I am sucking it up.



Edited 1 time(s). Last edit at 01/05/2021 09:33AM by susan.d.