What Is Sotalol? Uses, Dosage, and What You Need to Know in 2026

Sotalol is a prescription antiarrhythmic medication used to treat serious heart rhythm disorders. It has been available for decades under several brand names — Betapace, Betapace AF, Sorine, and Sotylize (the oral solution) — and its generic form is now widely prescribed. Here's a complete overview of what Sotalol is, what it treats, and what patients need to know before taking it.

What Is Sotalol?

Sotalol hydrochloride is a unique antiarrhythmic medication that has two distinct mechanisms of action: it is both a non-cardioselective beta-blocker (Class II antiarrhythmic) and a potassium channel blocker (Class III antiarrhythmic). This dual action makes it particularly effective for a range of heart rhythm disorders.

Sotalol is available in several formulations:

Generic Sotalol tablets: 80 mg, 120 mg, 160 mg, 240 mg — the most common form

Sotylize oral solution: 5 mg/mL, available in 250 mL or 480 mL bottles — used by patients who cannot swallow tablets, including young children and those with swallowing difficulties

IV Sotalol: Used in hospital settings for initiation; not available for home use

What Is Sotalol Used For?

Sotalol has two main FDA-approved indications:

Ventricular arrhythmias: Treatment of documented, hemodynamically stable ventricular tachycardia (a potentially life-threatening fast heart rhythm originating in the lower heart chambers)

Atrial fibrillation/flutter (AFib/AFL): Maintenance of normal sinus rhythm in patients with highly symptomatic paroxysmal (episodic) atrial fibrillation or atrial flutter who are currently in sinus rhythm

Off-label uses include premature ventricular contractions (PVCs), postoperative atrial fibrillation after cardiac surgery, supraventricular tachycardia (SVT), and treatment of fetal tachycardias through maternal administration.

Is Sotalol a Controlled Substance?

No. Sotalol is not a controlled substance and is not listed on the DEA schedule. It does not have abuse potential. However, it is a prescription-only medication that requires careful medical supervision, particularly during initiation, because of its cardiac safety risks.

Sotalol Dosage: How Is It Dosed?

Sotalol dosing depends on the indication and the patient's kidney function:

Starting dose: 80 mg twice daily (160 mg/day total), given in the hospital with monitoring

Titration: Dose increased by 80 mg/day every 3 days as long as the QTc interval remains below 500 msec

Therapeutic range: 160–320 mg/day in two or three divided doses for most patients

For AFib: 120 mg twice daily is typical; most patients find this effective

Renal dose adjustment: Dosing interval is extended for creatinine clearance 40–60 mL/min; Sotalol is contraindicated for AFib if CrCl < 40 mL/min

How Should I Take Sotalol?

Take Sotalol on an empty stomach or 1–2 hours before meals for best absorption

Take antacids at least 2 hours apart from Sotalol — antacids can reduce Sotalol absorption

Take doses approximately 12 hours apart if dosed twice daily

If you miss a dose, take it as soon as you remember — unless it's almost time for your next dose. Never double-dose

Most patients take Sotalol indefinitely — do not stop without your doctor's guidance

Who Should NOT Take Sotalol?

Sotalol is contraindicated in patients with:

Asthma or severe COPD

Existing long QT syndrome (congenital or acquired)

Significant sinus bradycardia (without a pacemaker)

Second or third degree heart block (without a pacemaker)

Cardiogenic shock or uncontrolled heart failure

Severe kidney impairment (CrCl < 40 mL/min for the AFib indication)

Finding Sotalol When Your Pharmacy Is Out of Stock

Generic Sotalol tablets are widely available at most pharmacies. The oral solution (Sotylize) can be harder to find — supply has been intermittently disrupted since 2020. If your pharmacy is out, medfinder contacts pharmacies near you to find which ones can fill your prescription, texting you the results.

For a full guide to Sotalol's safety profile, see: Sotalol Side Effects: What to Expect and When to Call Your Doctor.