Warning: Life-Threatening Proarrhythmia
See full prescribing information for complete boxed warning.
- Betapace/Betapace AF can cause life-threatening ventricular tachycardia associated with QT interval prolongation.
- If the QT interval prolongs to 500 msec or greater, reduce the dose, lengthen the dosing interval, or discontinue the drug.
- Initiate or reinitiate in a facility that can provide cardiac resuscitation and continuous electrocardiographic monitoring.
- Adjust the dosing interval based on creatinine clearance.
Contraindications
For the treatment of AFIB/AFL or ventricular arrhythmias:
- Sinus bradycardia, 2nd or 3rd degree atrioventricular (AV) block, sick sinus syndrome
- Congenital or acquired long QT syndrome
- Serum potassium <4 mEq/L
- Cardiogenic shock, decompensated heart failure
- Bronchial asthma or related bronchospastic conditions
For the treatment of AFIB/AFL also contraindicated for:
- QT interval >450 msec
Warnings and Precautions
- QT prolongation, bradycardia, AV block, hypotension, worsening heart failure: Reduce dose or discontinue
- Acute exacerbation of coronary artery disease upon cessation of therapy: Do not abruptly discontinue
- Correct any electrolyte disturbances
- May mask symptoms of hypoglycemia or worsen hyperglycemia in diabetic patients; monitor
Drug Interactions
- Class I or III Antiarrhythmics or other drugs that prolong the QT interval: Avoid concomitant use
- Digoxin, calcium channel blocker: increased risk of bradycardia, hypotension, heart failure
- Dosage of insulin or antidiabetic drugs may need adjustment
- Aluminum or magnesium based antacids reduce sotalol exposure
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Adverse Events
- The most common adverse reactions (≥2%) for Betapace are: fatigue 4%, bradycardia (less than 50 beats per minute) 3%, dyspnea 3%, proarrhythmia 3%, asthenia 2%, and dizziness 2%.
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Use In Specific Populations
- Lactation: Do not breastfeed