소탈롤
Sotalol
d,l-sotalol hydrochloride
다른 이름: Betapace · Sotacor · MJ-1999 · d,l-sotalol hydrochloride · sotaloli hydrochloridum · Sotalolum
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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 |
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
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 복서견의 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.
안전성·주의사항
금기사항
- 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
부작용
- 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)
주의
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.
약물 상호작용
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.
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)
- Renal function (BUN, Creatinine, SDMA)
- Serum electrolytes (especially potassium, to avoid hypokalaemia)
- Clinical signs of congestive heart failure
약동학
반감기
흡수
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.
분포
Relatively low lipid solubility and virtually no protein binding. Enters maternal milk in concentrations up to 5 times that found in serum.
대사
Minimal to no hepatic metabolism.
배설
Elimination is almost entirely via the kidneys, and most of the drug is excreted unchanged.
과다투여
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).
제품
제형
- 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)
인용의약품
- 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)
규제 현황
Human registered products used under the cascade.
POM (Prescription Only Medicine). Human registered products used under the cascade.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store tablets at room temperature.
보호자 정보
중요：수의사와 상의 없이 갑자기 투여를 중단하거나 용량을 변경하지 마십시오. 갑작스러운 투여 중단은 위험한 부정맥 악화나 혈압 상승을 유발할 수 있습니다.
- 투여 방법：최적의 흡수를 위해 반려동물이 잘 견딘다면 가급적 공복에 투여하십시오. 위장 장애가 발생하면 소량의 음식과 함께 투여할 수 있습니다.
- 관찰 및 모니터링：반려동물에게 극심한 피로, 쇠약, 실신 또는 호흡 곤란의 징후가 나타나는지 주의 깊게 관찰하십시오.
- 연락：구토, 무기력 또는 호흡 문제가 발견되면 즉시 수의사에게 연락하십시오. 약물이 안전하게 작용하는지 확인하기 위해 심전도(ECG) 모니터링을 위한 재진 일정을 반드시 지켜주십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.