Your Patients Can't Find Sotylize — Here's How You Can Help

As a cardiologist or electrophysiologist, you know that continuity of antiarrhythmic therapy is critical. When patients can't fill their Sotylize (Sotalol hydrochloride oral solution) prescription, it's not just an inconvenience — it's a clinical risk. Abrupt discontinuation of Sotalol can lead to rebound tachycardia and arrhythmia recurrence.

This guide provides actionable steps your practice can take to help patients navigate Sotylize availability challenges in 2026.

Current Availability of Sotylize

Sotylize oral solution (5 mg/mL) continues to experience intermittent supply disruptions in 2026. The root causes remain consistent:

• Very few manufacturers produce the oral solution formulation
• Most retail pharmacies do not stock it due to low demand
• Periodic manufacturing and raw material disruptions further constrain supply

Generic Sotalol tablets remain widely available and are not affected. The shortage is specific to the oral solution — the formulation needed by patients who cannot swallow tablets, including pediatric patients and those with dysphagia.

For the complete shortage timeline and clinical context, see: Sotylize Shortage: What Providers Need to Know in 2026.

Why Patients Can't Find It

Understanding the patient experience is important. Here's what your patients typically encounter:

1. They bring their prescription to a chain pharmacy
2. The pharmacy doesn't stock Sotylize and offers to order it
3. The order comes back as unavailable from the wholesaler
4. The patient calls 5-10 more pharmacies with similar results
5. They contact your office, frustrated and running low on medication

This cycle is common with niche medications. The good news: with the right approach, it's usually solvable.

What Providers Can Do: 5 Practical Steps

Step 1: Use Medfinder for Real-Time Availability Checks

Medfinder for Providers allows your staff to search for Sotylize availability by zip code in real time. Instead of having patients (or your team) call pharmacies one by one, Medfinder shows which pharmacies currently have it in stock.

Consider integrating Medfinder checks into your workflow whenever prescribing Sotylize or responding to patient refill issues.

Step 2: Establish Compounding Pharmacy Relationships

Compounding pharmacies can prepare Sotalol hydrochloride oral solution (typically at 5 mg/mL) from USP-grade ingredients. This provides a reliable backup when the manufactured product is unavailable.

Recommendations:

• Identify 1-2 compounding pharmacies in your area that handle cardiac medications
• Verify they follow USP <797> standards for sterility and quality
• Keep their contact information on file for your prescribing team
• Write prescriptions specifying the compounded formulation when needed

Compounded Sotalol oral solution typically costs $50 to $150 per month — significantly less than brand-name Sotylize ($300-$600).

Step 3: Document Clinical Necessity for Prior Authorizations

Many insurance plans require prior authorization for brand-name Sotylize and may apply step therapy (requiring trial of tablets first). Having thorough documentation in the patient's chart accelerates this process.

Key points to document:

• Specific reason the oral solution is needed (dysphagia, pediatric dosing, precise titration)
• Why tablets are not appropriate for this patient
• Previous attempts to use alternative formulations (if any)

Step 4: Proactively Educate Patients About Refill Timing

Advise patients to begin the refill process 7-10 days before they run out. Many availability issues can be resolved within a few days if the pharmacy has lead time to source the medication.

Consider providing a printed handout or directing patients to: How to Find Sotylize in Stock Near You.

Step 5: Have a Contingency Plan Ready

For each patient on Sotylize, have a documented contingency plan in the chart:

• Can this patient switch to Sotalol tablets if needed?
• If not, which compounding pharmacy should we use?
• Is there an appropriate alternative antiarrhythmic?
• What is the maximum number of days this patient can safely miss?

Having this plan pre-established avoids scrambling during an acute supply disruption.

Alternative Antiarrhythmic Medications

When Sotalol in any form is unavailable, the following alternatives may be considered based on the patient's clinical profile:

• Amiodarone (Cordarone, Pacerone): Broad-spectrum Class III antiarrhythmic. Effective for both atrial and ventricular arrhythmias. Requires long-term monitoring for thyroid, pulmonary, and hepatic toxicity. Generic: $15-$50/month.
• Dofetilide (Tikosyn): Pure Class III antiarrhythmic for AF/AFL. Requires in-hospital initiation and REMS-certified pharmacy. Cost: $200-$400/month.
• Dronedarone (Multaq): Class III option for paroxysmal or persistent AF. Contraindicated in NYHA Class IV heart failure and permanent AF. Brand-only: $300-$500/month.
• Flecainide: Class IC option for AF in structurally normal hearts. Usually paired with a rate-controlling agent. Generic: $20-$60/month.

For the patient-facing version of this information: Alternatives to Sotylize.

Workflow Tips for Your Practice

• Flag Sotylize patients in your EHR — set up alerts or a patient list so your team can proactively monitor their refill status
• Assign a pharmacy liaison — designate a staff member to handle medication availability issues, including Medfinder searches and compounding pharmacy coordination
• Keep a shortage resource folder — bookmark the FDA Drug Shortages database, Medfinder for Providers, and local compounding pharmacy contacts
• Coordinate with referring providers — if patients are co-managed with a pediatric cardiologist or internist, ensure everyone is aligned on the backup plan

Final Thoughts

The Sotylize supply challenge isn't going away soon, but it's manageable with proactive planning. The combination of real-time tools like Medfinder, compounding pharmacy partnerships, and clear contingency protocols can keep your patients safely on therapy.

The key is shifting from reactive problem-solving (scrambling when a patient calls) to a proactive system that anticipates supply issues before they become clinical emergencies.

For the broader clinical context on this shortage, see: Sotylize Shortage: What Providers and Prescribers Need to Know in 2026.

For cost and financial assistance resources to share with patients: How to Help Patients Save Money on Sotylize.