ソタロール
Sotalol
d,l-sotalol hydrochloride
別名: Betapace · Sotacor · MJ-1999 · d,l-sotalol hydrochloride · sotaloli hydrochloridum · Sotalolum
VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
動物種別用量
🌎 NA — North America🌍 EU — Europe
犬
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| General antiarrhythmic | 1-2 mg/kg | PO | q12h | — | 🌎 NA |
| General antiarrhythmic | 1-3 mg/kg | PO | twice daily | — | 🌎 NA |
| For ventricular tachycardia | 1-2 mg/kg | PO | twice daily | — | 🌎 NA |
| For ventricular tachyarrhythmias in Boxers in combination with mexiletine | 1.5-3 mg/kg | PO | twice daily | — | 🌎 NA |
| In Boxers | 40-80 mg (total dose) | PO | q12h | — | 🌎 NA |
| Ventricular arrhythmias | 0.5-3 mg/kg | PO | q12h | Ongoing | 🌍 EU |
| Ventricular arrhythmias (Acute/Severe) | 0.5 mg/kg given over 2 min, up to 3 times (to a total dose of 1.5 mg/kg) | IV | As needed | Acute setting | 🌍 EU |
- For ventricular tachyarrhythmias in Boxers in combination with mexiletine: Given with mexiletine (5-7.5 mg/kg PO three times daily)
- Ventricular arrhythmias: Start with lower doses if myocardial function is reduced.
- Ventricular arrhythmias (Acute/Severe): Anecdotal dosing.
猫
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| General antiarrhythmic | 2 mg/kg | PO | twice daily | — | 🌎 NA |
| For ventricular tachyarrhythmias | 2 mg/kg | PO | q12h | — | 🌎 NA |
| General antiarrhythmic | 1-2 mg/kg | PO | q12h | — | 🌎 NA |
| General antiarrhythmic | 1/8th of an 80 mg tablet (approximately 2 mg/kg) | PO | twice daily | — | 🌎 NA |
| Ventricular arrhythmias | 10-20 mg/cat | PO | q12h | Ongoing | 🌍 EU |
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
概要
ソタロール（Sotalol）は、非選択的β遮断薬（クラスII）およびカリウムチャネル遮断薬（クラスIII）の両方の特性を併せ持つユニークな抗不整脈薬です。
- 臨床的有用性：獣医療では主に犬や猫の心室頻拍の治療に使用され、場合によっては上室性頻拍にも使用されます。
- 対象動物：特にボクサー犬の心室性不整脈（不整脈源性右室心筋症：ARVCに関連することが多い）や、リドカイン不応性の症例の管理に好んで用いられます。
- 薬理学的特徴：ソタロールはラセミ体です。d-体およびl-体の両方がクラスIII抗不整脈作用を示しますが、β遮断作用を持つのはl-体のみです。そのβ遮断作用の強さはプロプラノロールの約30%です。
作用機序
Sotalol exerts a dual mechanism of action:
- Class II (Beta-Blocking) Action: Competitively antagonizes non-selective $\beta_1$ and $\beta_2$ adrenergic receptors $\rightarrow$ decreases heart rate, slows AV nodal conduction, and exerts a negative inotropic effect on the myocardium.
- Class III (Antiarrhythmic) Action: Selectively inhibits the rapid delayed rectifier potassium current ($I_{Kr}$) $\rightarrow$ prolongs the action potential duration (APD) and the effective refractory period (ERP) in both atrial and ventricular myocardium without affecting depolarization or conduction velocity.
安全性・警告
禁忌
- Asthma or reactive airway disease
- Sinus bradycardia
- 2nd or 3rd degree AV block (unless artificially paced)
- Long QT syndromes
- Cardiogenic shock
- Uncontrolled congestive heart failure (CHF)
- Atrioventricular (AV) block
- Decompensated congestive heart failure (CHF)
- Long QT interval on ECG
有害事象
- Negative inotropism (decreased heart contractility)
- Proarrhythmia (can induce new or worsen existing arrhythmias)
- Dyspnea / Bronchospasm
- Fatigue / Lethargy
- Dizziness / Syncope exacerbation
- Nausea / Vomiting
- Bradycardia
- Hypotension
- Bradyarrhythmias
- Depression
- Diarrhoea
- Decreased cardiac output
- Precipitation of congestive heart failure
- Prolonged QT interval
- Torsades de pointes (proarrhythmic effect)
注意事項
Use with caution in patients with congestive heart failure (due to negative inotropic effects), diabetes mellitus, or hyperthyroidism (may mask clinical signs of hypoglycemia or thyrotoxicosis). Use with caution in patients with renal dysfunction; dosage intervals may need to be extended as it is renally excreted. Safety in pregnancy is not fully established (FDA Category B). Sotalol enters maternal milk at up to 5x serum concentrations; consider milk replacer for nursing animals.
医薬品相互作用
May prolong refractory periods; concurrent use not recommended.
Additive myocardial depression may occur.
May reduce oral sotalol absorption; separate doses by at least 2 hours.
May prolong refractory periods and QT interval; concurrent use not recommended.
May prolong QT interval.
Potential to increase hypotensive effects; additive effects on AV conduction or ventricular function. Use with caution.
May prolong QT interval.
Increased risk for rebound hypertension if clonidine is discontinued after concomitant therapy.
Potential for increased risks for proarrhythmic events.
May prolong QT interval.
Clearance of lidocaine may be impaired by sotalol.
May prolong QT interval.
May have additive hypotensive and bradycardic effects.
Actions may be blocked by sotalol.
May prolong QT interval.
Mutual antagonism; sotalol may block their actions, and they may reduce sotalol's efficacy.
Additive myocardial depression.
Additive myocardial depression.
Enhanced hypotensive effects; risk of hypokalaemia which increases risk of torsades de pointes.
Enhanced hypotensive effects.
May prolong hypoglycaemic effects of insulin therapy.
Additive negative inotropic effects; use with extreme caution in patients with systolic dysfunction or CHF.
監視
- Efficacy via Electrocardiogram (ECG)
- Adverse effects (heart rate, blood pressure, respiratory effort)
- Renal function (baseline and periodic, as drug is renally excreted)
- Blood glucose (especially in diabetic patients)
- Heart rate and rhythm (Holter ECG monitoring is highly recommended to assess efficacy and detect proarrhythmias)
- Renal function (BUN, Creatinine, SDMA)
- Serum electrolytes (especially potassium, to avoid hypokalaemia)
- Clinical signs of congestive heart failure
薬物動態
半減期
吸収
Bioavailability is 90-100% if given on an empty stomach. Food may reduce bioavailability by approximately 20%. Unlike propranolol, sotalol does not have any appreciable first-pass effect.
分布
Relatively low lipid solubility and virtually no protein binding. Enters maternal milk in concentrations up to 5 times that found in serum.
代謝
Minimal to no hepatic metabolism.
消失
Elimination is almost entirely via the kidneys, and most of the drug is excreted unchanged.
過剰投与
Overdoses may result in bradycardia, hypotension, congestive heart failure, bronchospasm, and hypoglycemia.
- Treatment: Use gut evacuation (emesis or gastric lavage) if not contraindicated and when there is a significant risk of morbidity.
- Supportive Care: Treat adverse effects symptomatically and supportively (e.g., atropine for bradycardia, fluids/vasopressors for hypotension, bronchodilators for bronchospasm).
製品
製剤
- Tablets
- Injection solution concentrate
- 40 mg oral tablet
- 80 mg oral tablet
- 160 mg oral tablet
- 200 mg oral tablet
- 10 mg/ml injectable solution
- 10 mg oral tablet (special reformulation)
- 30 mg oral tablet (special reformulation)
ヒト用医薬品
- Sotalol HCl Tablets: 80 mg, 120 mg, 160 mg & 240 mg; Betapace® (Bayer); generic
- Sotalol Injection Solution Concentrate: 15 mg/mL in 10 mL vials; generic
- Sotacor tablets
- Sotalol generic tablets (40 mg, 80 mg, 160 mg, 200 mg)
- Sotalol generic injection (10 mg/ml)
規制ステータス
Human registered products used under the cascade.
POM (Prescription Only Medicine). Human registered products used under the cascade.
規制データなし: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
保管・安定性
Store tablets at room temperature.
飼主向け情報
重要：獣医師の指示なしに、突然の休薬や用量の変更を行わないでください。急に薬をやめると、危険な不整脈の悪化や血圧の反跳を招く恐れがあります。
- 投与方法：吸収を良くするため、ペットが許容できる場合は空腹時に投与してください。胃腸障害が見られる場合は、少量の食事と一緒に与えても構いません。
- 観察とモニタリング：ペットに極度の疲労感、脱力感、失神、または呼吸困難の兆候がないか注意深く観察してください。
- 連絡：嘔吐、無気力、呼吸器系の問題が見られた場合は、直ちに獣医師にご連絡ください。薬が安全に効いているか確認するため、心電図（ECG）モニタリングの再診は必ず受けてください。
VetSheet医薬品リファレンスは獣医専門家の臨床意思決定支援を目的としており、専門的判断または製造業者の最新医薬品情報の代替にはなりません。