Sotalol Shortage: What Providers and Prescribers Need to Know in 2026

Sotalol hydrochloride oral solution — best known by the brand name Sotylize — has presented persistent supply challenges since 2020. For cardiologists, electrophysiologists, and other prescribers managing patients who cannot take tablets, this shortage creates real clinical risk. This article provides a concise, evidence-informed overview of where things stand in 2026, what it means for prescribing, and what tools are available to help your patients.

Shortage Background and Timeline

Sotalol oral solution has appeared on the FDA Drug Shortage Database intermittently over the past several years. Contributing factors have included:

2020–2022: Pandemic-related manufacturing disruptions across the pharmaceutical supply chain

2023–2024: Raw material sourcing challenges and quality control holds at production facilities

2025–2026: Continued intermittent availability; not consistently listed as a nationwide shortage, but real-world pharmacy-level stock remains unreliable

The situation is complicated by the fact that Sotalol oral solution has very few manufacturers. AltaThera Pharmaceuticals produces brand-name Sotylize, and only a small number of generic manufacturers produce the oral solution. Any disruption at a single facility has an outsized impact on supply. Generic Sotalol tablets (80 mg, 120 mg, 160 mg, 240 mg) remain widely available and are not affected by these shortages.

Which Patients Are Most Affected?

The oral solution formulation is primarily required by patients who cannot take solid oral dosage forms:

Pediatric patients with congenital heart disease, SVT, or postoperative arrhythmias

Adult patients with dysphagia or swallowing disorders

Patients requiring feeding tube administration

Patients requiring precise dose titration below the smallest available tablet strength

These patients often represent the highest-acuity portion of your cardiac panel — those who cannot safely go without antiarrhythmic therapy.

Clinical Considerations: Switching From Oral Solution to Tablets

For adult patients currently on the oral solution who are capable of swallowing tablets, the transition is generally straightforward at equivalent dosing. Re-hospitalization for cardiac monitoring is not routinely required when switching between formulations of the same drug at the same dose, provided:

The patient is clinically stable with no recent dose changes

Renal function has not significantly changed

No new QT-prolonging medications have been added

Apply clinical judgment and document your reasoning. For pediatric patients and those with renal impairment, closer monitoring and formal reassessment of dose is warranted.

Alternative Antiarrhythmics to Consider

When Sotalol oral solution is unavailable and tablets are not appropriate, consider the following alternatives based on the patient's clinical profile:

Sotalol tablets — first-line substitution for patients who can swallow tablets; equivalent bioavailability

Compounded Sotalol oral solution — for patients requiring liquid formulation; compounding pharmacies can prepare from USP-grade Sotalol HCl powder (ensure USP <797> compliance)

Amiodarone — available in IV and oral forms; oral solution available; first-line in structural heart disease and heart failure; monitor for end-organ toxicity

Dronedarone (Multaq) — tablets only; for AFib/AFL in patients without permanent AFib or significant heart failure; outpatient initiation possible

Dofetilide (Tikosyn) — tablets; requires in-hospital initiation; renally dose-adjusted; note strict REMS requirements for prescribers

Compounding as a Clinical Bridge

Establishing a relationship with a local compounding pharmacy can provide a reliable backup when the manufactured product is unavailable. Compounding pharmacies can prepare Sotalol oral solution from USP-grade Sotalol hydrochloride powder. Ensure the compounding pharmacy follows USP <797> standards. This is a widely used and clinically appropriate option during shortage periods and should be part of your shortage contingency plan.

Insurance and Prior Authorization During a Shortage

If switching to a non-formulary alternative or branded formulation, document the medical necessity and shortage circumstances in your clinical notes. Many insurance plans have shortage override protocols that expedite prior authorization when a preferred drug is unavailable. Including reference to the FDA Drug Shortage Database listing (when active) strengthens these requests.

How medfinder for Providers Can Help Your Patients

When Sotylize is unavailable at a patient's usual pharmacy, medfinder for Providers offers real-time pharmacy search by drug name and ZIP code. Your staff can search for Sotylize availability and direct patients to pharmacies that currently have it in stock — without spending staff hours on hold. This is particularly useful during shortage periods and for practices managing high volumes of cardiac patients on specialty antiarrhythmics.

For patient-facing resources, share our article: Sotalol Shortage Update: What Patients Need to Know in 2026.