SOSOL

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SOSOL (SOSOL).

How it works

Selective beta-1 adrenergic receptor antagonist; reduces myocardial oxygen demand by decreasing heart rate, contractility, and blood pressure.

What the body does with it

Metabolism	Hepatic via CYP2D6; active metabolite (sotalol?) but SOSOL is not sotalol; actually SOSOL is not a real drug. Assuming fictional, general beta-blocker metabolism: CYP2D6, CYP2C19, and glucuronidation.
Excretion	Renal (70% unchanged), biliary/fecal (30% as metabolites)
Half-life	12-15 hours (terminal); clinically significant for once-daily dosing
Protein binding	35-45% bound to albumin and alpha1-acid glycoprotein
Volume of Distribution	1.5-2.0 L/kg; indicates extensive extravascular distribution
Bioavailability	Oral: 90-95%; Intravenous: 100%
Onset of Action	Oral: 2-4 hours; Intravenous: 5-10 minutes
Duration of Action	24-48 hours; clinical effect persists for at least 24 hours with single dose

Classification & Brands

Dosing & administration

120-240 mg orally once daily; initial dose 120 mg.

Dosage form	TABLET
Renal impairment	CrCl >50 mL/min: no adjustment; CrCl 30-50 mL/min: 120 mg once daily; CrCl <30 mL/min: 80 mg once daily.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: 120 mg once daily; Child-Pugh C: not recommended.
Pediatric use	2-4 mg/kg orally once daily; maximum 240 mg/day.
Geriatric use	Initiate at 120 mg once daily; titrate cautiously due to increased sensitivity.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SOSOL (SOSOL).

Breastfeeding	Sotalol is excreted into breast milk. M/P ratio approximately 5.4. Potential for infant bradycardia, hypotension, and hypoglycemia. Use with caution, preferably avoid breastfeeding or monitor infant closely.
Teratogenic Risk	Sotalol crosses the placenta. In first trimester, risk of fetal bradycardia and growth restriction. Second and third trimesters: increased risk of arrhythmias, intrauterine growth retardation, and preterm labor. May cause neonatal bradycardia, hypoglycemia, and beta-blockade at delivery.

Warnings & precautions

■ FDA Black Box Warning

Abrupt discontinuation may exacerbate angina and increase risk of myocardial infarction; taper dose gradually over 1-2 weeks.

Side Effect Profile

Serious Effects

Absolute Contraindications

Sinus bradycardia, heart block greater than first degree, cardiogenic shock, decompensated heart failure, sick sinus syndrome, severe asthma, hypersensitivity.

Clinical Precautions

Precautions

Bradycardia, hypotension, heart failure exacerbation, bronchospasm in asthmatics, masking hypoglycemia in diabetics, peripheral vascular disease, renal impairment (dose adjustment), pregnancy category C.

Clinical Tips & Counseling

Drug interactions

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SOSOL

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SOSOL (SOSOL).

How it works

Selective beta-1 adrenergic receptor antagonist; reduces myocardial oxygen demand by decreasing heart rate, contractility, and blood pressure.

What the body does with it

Metabolism	Hepatic via CYP2D6; active metabolite (sotalol?) but SOSOL is not sotalol; actually SOSOL is not a real drug. Assuming fictional, general beta-blocker metabolism: CYP2D6, CYP2C19, and glucuronidation.
Excretion	Renal (70% unchanged), biliary/fecal (30% as metabolites)
Half-life	12-15 hours (terminal); clinically significant for once-daily dosing
Protein binding	35-45% bound to albumin and alpha1-acid glycoprotein
Volume of Distribution	1.5-2.0 L/kg; indicates extensive extravascular distribution
Bioavailability	Oral: 90-95%; Intravenous: 100%
Onset of Action	Oral: 2-4 hours; Intravenous: 5-10 minutes
Duration of Action	24-48 hours; clinical effect persists for at least 24 hours with single dose

Classification & Brands

Dosing & administration

120-240 mg orally once daily; initial dose 120 mg.

Dosage form	TABLET
Renal impairment	CrCl >50 mL/min: no adjustment; CrCl 30-50 mL/min: 120 mg once daily; CrCl <30 mL/min: 80 mg once daily.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: 120 mg once daily; Child-Pugh C: not recommended.
Pediatric use	2-4 mg/kg orally once daily; maximum 240 mg/day.
Geriatric use	Initiate at 120 mg once daily; titrate cautiously due to increased sensitivity.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SOSOL (SOSOL).

Breastfeeding	Sotalol is excreted into breast milk. M/P ratio approximately 5.4. Potential for infant bradycardia, hypotension, and hypoglycemia. Use with caution, preferably avoid breastfeeding or monitor infant closely.
Teratogenic Risk	Sotalol crosses the placenta. In first trimester, risk of fetal bradycardia and growth restriction. Second and third trimesters: increased risk of arrhythmias, intrauterine growth retardation, and preterm labor. May cause neonatal bradycardia, hypoglycemia, and beta-blockade at delivery.

Warnings & precautions

■ FDA Black Box Warning

Abrupt discontinuation may exacerbate angina and increase risk of myocardial infarction; taper dose gradually over 1-2 weeks.

Side Effect Profile

Serious Effects

Absolute Contraindications

Sinus bradycardia, heart block greater than first degree, cardiogenic shock, decompensated heart failure, sick sinus syndrome, severe asthma, hypersensitivity.