General steps in determining the dose in the adult:
(1) The patient should be admitted to a health care facility where the ECG can be monitored.
(2) The creatinine clearance is estimated based on age, body weight and serum creatinine levels.
(3) If contraindications are present then the drug is not given.
(4) The initial dosing interval is selected based on the creatinine clearance.
(5) The dose can be increased gradually based on arrhythmia control and effect on the QT interval. The maximum recommended daily dose is 160 mg BID if creatinine clearance is > 60 mL/min and 160 mg qd if the creatinine clearance is 40 – 60 mL/min
(6) Monitor the QT for 2-4 hours after each dose. Discontinue if QT > 500 msec during initial dosing.
(7) The person should be monitored for at least 3 days after dosing changes (up to 6 days on QD schedule).
Contraindications to therapy with sotalol:
(1) creatinine clearance < 40 mL per minute
(2) QT > 450 msec before initiation (or JT>= 330 msec if the QRS is over 100 msec)
where:
• The PDR uses QT interval and not QTc.
