소탈롤

베타 차단제 / 제3형 항부정맥제

소탈롤(Sotalol)은 **비선택적 베타 차단제(제2형)**와 **칼륨 통로 차단제(제3형)**의 특성을 모두 가진 독특한 항부정맥제입니다. * **임상적 유용성**：수의학에서는 주로 개와 고양이의 심실빈맥 치료에 사용되며, 간혹 상심실성 빈맥에도 사용됩니다. * **대상 동물**：특히 **복서견**의 심실성 부정맥(주로 부정맥유발성 우심실 심근병증, ARVC와 관련됨) 관리나 리도카인에 반응하지 않는 증례에 선호됩니다. * **약리학적 특징**：소탈롤은 라세미 혼합물입니다. *d-* 이성질체와 *l-* 이성질체 모두 제3형 항부정맥 활성을 나타내지만, 베타 차단 활성은 *l-* 이성질체만 가지고 있습니다. 베타 차단 효능은 프로프라놀롤의 약 30% 수준입니다.

작용 기전: 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.

동물 종별 용량

Cats

General antiarrhythmic · 2 mg/kg · PO · twice daily
For ventricular tachyarrhythmias · 2 mg/kg · PO · q12h
General antiarrhythmic · 1-2 mg/kg · PO · q12h
General antiarrhythmic · 1/8th of an 80 mg tablet (approximately 2 mg/kg) · PO · twice daily
Ventricular arrhythmias · 10-20 mg/cat · PO · q12h · Ongoing

Dogs

General antiarrhythmic · 1-2 mg/kg · PO · q12h
General antiarrhythmic · 1-3 mg/kg · PO · twice daily
For ventricular tachycardia · 1-2 mg/kg · PO · twice daily
For ventricular tachyarrhythmias in Boxers in combination with mexiletine · 1.5-3 mg/kg · PO · twice daily · Given with mexiletine (5-7.5 mg/kg PO three times daily)
In Boxers · 40-80 mg (total dose) · PO · q12h
Ventricular arrhythmias · 0.5-3 mg/kg · PO · q12h · Ongoing · Start with lower doses if myocardial function is reduced.
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 · Anecdotal dosing.

투여 경로

POIV

금기

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)
Asthma
Atrioventricular (AV) block
Decompensated congestive heart failure (CHF)
Long QT interval on ECG

이상반응

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
Bronchospasm
Depression
Nausea
Vomiting
Diarrhoea
Decreased cardiac output
Precipitation of congestive heart failure
Prolonged QT interval

약물 상호작용

Amiodarone · May prolong refractory periods; concurrent use not recommended.
Anesthetics, General · Additive myocardial depression may occur.
Antacids · May reduce oral sotalol absorption; separate doses by at least 2 hours.
Antiarrhythmics, Class IA (quinidine, procainamide, disopyramide) · May prolong refractory periods and QT interval; concurrent use not recommended.
Antiarrhythmics, Class IB/IC (lidocaine, mexiletine, phenytoin, flecainide) · May prolong QT interval.
Calcium Channel Blockers (verapamil, diltiazem) · Potential to increase hypotensive effects; additive effects on AV conduction or ventricular function. Use with caution.
Cisapride · May prolong QT interval.
Clonidine · Increased risk for rebound hypertension if clonidine is discontinued after concomitant therapy.
Digoxin · Potential for increased risks for proarrhythmic events.
Erythromycin / Clarithromycin · May prolong QT interval.
Lidocaine · Clearance of lidocaine may be impaired by sotalol.
Phenothiazines · May prolong QT interval. · moderate

모니터링

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)
Blood pressure
Renal function (BUN, Creatinine, SDMA)
Serum electrolytes (especially potassium, to avoid hypokalaemia)
Clinical signs of congestive heart failure

과용량

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).

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