A clinical briefing on the Sotylize (Sotalol oral solution) shortage for cardiologists and prescribers: availability updates, alternatives, and patient tools.
As a prescriber of antiarrhythmic medications, you're likely aware that Sotylize (Sotalol hydrochloride oral solution, 5 mg/mL) has been subject to intermittent supply disruptions. This article provides an up-to-date overview of the situation, its clinical implications, and tools you can use to help your patients maintain access to therapy.
Sotylize serves a specific patient population — primarily pediatric patients, individuals with dysphagia, and patients requiring precise dose titration that the oral solution facilitates. When supply is disrupted, these patients are disproportionately affected because they cannot simply switch to the widely available tablet formulation.
Sotalol oral solution has appeared on the FDA drug shortage list intermittently over the past several years. Contributing factors have included:
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 Sotalol oral solution. Any disruption at a single facility has an outsized impact on supply.
Sotalol tablets (generic 80 mg, 120 mg, 160 mg, 240 mg) remain widely available and are not affected by these shortages.
The intermittent nature of this shortage creates several prescribing challenges:
Sotalol should not be discontinued abruptly due to the risk of rebound tachycardia and arrhythmia exacerbation — a property shared with all beta-blockers. Patients who suddenly lose access to their supply may be at risk if they cannot fill their prescription promptly.
Sotalol requires in-hospital initiation with continuous ECG monitoring for a minimum of 3 days (per the boxed warning). If a patient is initiated on the oral solution and later forced to switch formulations due to shortage, the transition should be carefully managed — although switching between oral solution and tablets of the same drug does not typically require re-hospitalization if the dose remains the same.
Pediatric patients represent the most vulnerable population during Sotylize shortages. Weight-based dosing with an oral solution offers precision that tablets cannot match, particularly for infants and young children. Compounding may be necessary (see below).
As of early 2026:
You can direct patients (and your staff) to Medfinder for Providers to check real-time pharmacy stock. This can save your team significant time compared to calling pharmacies manually.
Cost may be a barrier for patients, particularly those without insurance or with high-deductible plans:
Insurance coverage for the brand-name oral solution often requires prior authorization. Many plans apply step therapy, requiring documentation that tablets are not appropriate before covering the oral solution. Having a clear clinical rationale in the patient's chart (e.g., pediatric patient, documented dysphagia, need for precise titration) streamlines this process.
For patients needing financial help, manufacturer assistance programs and third-party resources like NeedyMeds and RxAssist are available. See our patient-facing guide: How to Save Money on Sotylize.
Medfinder offers real-time pharmacy inventory data. Your staff can search for Sotylize availability by zip code and direct patients to pharmacies that currently have it in stock. This is particularly useful during shortage periods.
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.
The FDA maintains a searchable database of current and resolved drug shortages at accessdata.fda.gov/scripts/drugshortages. This is the authoritative source for official shortage status.
Consider sharing these resources with patients who are struggling to find Sotylize:
When Sotylize is unavailable, consider the following alternatives based on the patient's clinical profile:
For a patient-facing comparison, see: Alternatives to Sotylize.
The fundamental drivers of Sotylize supply instability — limited manufacturers, small market size, and fragile supply chains — are unlikely to resolve in the near term. Providers who proactively develop contingency plans (compounding partnerships, patient education, alternative protocols) will be best positioned to maintain continuity of care.
We recommend:
The Sotylize shortage is a manageable challenge, but it requires proactive planning. By leveraging real-time tools like Medfinder, establishing compounding relationships, and maintaining clear documentation, you can help ensure your patients continue to receive the antiarrhythmic therapy they need.
For the provider-specific guide on helping patients find this medication, see: How to Help Your Patients Find Sotylize in Stock.
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