Comprehensive medication guide to Sotalol including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$15 copay for generic tablets (Tier 1–2 on most plans). Sotalol oral solution may require prior authorization; step therapy requiring generic trial first is common. Medicare Part D typically covers generic tablets at low or no cost.
Estimated Cash Pricing
$10–$45 retail for generic tablets (80–240 mg); as low as $7.74 with a GoodRx coupon for a 30-day supply. Sotalol oral solution (Sotylize) costs $300–$600/month brand or $150–$350/month generic without insurance.
Medfinder Findability Score
68/100
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Sotalol is a prescription antiarrhythmic medication used to treat serious heart rhythm disorders, including ventricular tachycardia and atrial fibrillation (AFib). It is sold under the brand names Betapace, Betapace AF, Sorine, and Sotylize (the oral solution formulation). Generic sotalol tablets are widely available and are the most commonly prescribed form.
Sotalol is unique among antiarrhythmics in that it acts through two distinct mechanisms: it is both a non-cardioselective beta-blocker (Class II) and a potassium channel blocker (Class III). This dual action makes it effective for a range of heart rhythm disorders where other medications may be less appropriate.
Sotalol is FDA-approved for two indications: hemodynamically stable ventricular tachycardia, and maintenance of normal sinus rhythm in patients with paroxysmal atrial fibrillation or flutter. It is also used off-label for premature ventricular contractions (PVCs), supraventricular tachycardia (SVT), postoperative AFib, and fetal arrhythmias via maternal administration.
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Sotalol works through two complementary mechanisms. As a Class II antiarrhythmic (beta-blocker), it blocks beta-adrenergic receptors in the heart, slowing the rate at which the sinoatrial node generates electrical impulses, reducing conduction through the AV node, and decreasing overall cardiac excitability. The beta-blocking effect begins at doses as low as 25 mg/day.
As a Class III antiarrhythmic, sotalol blocks potassium channels (IKr and IKs) that control repolarization of the cardiac action potential during Phase 3. This prolongs the action potential duration and extends the effective refractory period — the window during which the heart cannot fire again. This Class III effect interrupts the abnormal reentry circuits that cause many arrhythmias and only becomes clinically significant at doses of 160 mg/day or higher.
The QT interval on ECG is prolonged by sotalol as part of this Class III mechanism — a double-edged effect that gives sotalol its antiarrhythmic potency but also creates pro-arrhythmic risk (torsade de pointes) if the QT interval prolongs excessively. This is why sotalol must be initiated in a hospital with continuous ECG monitoring and QTc measurement after each dose adjustment.
80 mg — tablet
Standard starting dose; taken twice daily
120 mg — tablet
Common maintenance dose for AFib patients
160 mg — tablet
Common therapeutic dose for ventricular arrhythmias
240 mg — tablet
Higher dose for refractory arrhythmias
5 mg/mL — oral solution
Sotylize; for patients unable to swallow tablets, including pediatric patients
Generic sotalol tablets (80 mg, 120 mg, 160 mg, 240 mg) are widely available at most retail pharmacies and are not experiencing any significant shortage. Patients on the tablet form are unlikely to encounter major availability issues.
The oral solution formulation — brand-name Sotylize and generic sotalol oral solution — is a different story. It has experienced intermittent supply disruptions since 2020 due to manufacturing challenges, a limited number of manufacturers (primarily AltaThera Pharmaceuticals for the brand), and low market demand that discourages new market entrants. As of early 2026, the oral solution continues to have inconsistent pharmacy-level availability, even when not formally listed on the FDA Drug Shortage Database.
If you're having trouble finding sotalol at your pharmacy, medfinder contacts pharmacies in your area to find which ones have it in stock, texting you the results. This is far faster than calling pharmacies yourself — especially for the oral solution, which may only be stocked at a handful of pharmacies in your region.
Sotalol is not a controlled substance, so no DEA registration is required to prescribe it. However, because the FDA mandates in-hospital initiation with continuous ECG monitoring for at least 3 days, sotalol must be started by a prescriber with access to inpatient cardiac monitoring facilities. In practice, this means initiation is performed by cardiologists or cardiac electrophysiologists.
Cardiologists — primary prescribers for adult patients with AFib and ventricular arrhythmias
Cardiac Electrophysiologists — subspecialists for complex arrhythmia cases
Pediatric Cardiologists — for children with congenital heart disease, SVT, or pediatric arrhythmias requiring the oral solution
Internists and Primary Care Providers — may manage ongoing refills for stable patients already initiated by a cardiologist
Nurse Practitioners and Physician Assistants — may prescribe refills under cardiologist supervision
Telehealth prescribing is not appropriate for new sotalol initiation because of the required in-hospital monitoring mandate. However, telehealth cardiology services may be used for stable patient follow-up and refill management. Find a cardiologist through the American College of Cardiology (acc.org) or Heart Rhythm Society (hrsonline.org) physician finders.
No. Sotalol is not a controlled substance and is not listed on any DEA schedule. It does not have abuse potential or dependence liability. Any licensed prescriber can write for sotalol without DEA registration requirements, special prescription pads, or quantity or refill limitations based on controlled substance rules.
While sotalol is not controlled, it is a serious cardiac medication that requires significant medical supervision. The FDA mandates in-hospital initiation with continuous ECG monitoring for at least 3 days because of its risk of causing dangerous arrhythmias (torsade de pointes). Refills for stable outpatients can be managed by a cardiologist, internist, or in some cases a primary care provider. Telehealth prescribing is not appropriate for new prescriptions but may be used for stable refills.
Most patients experience some of these common side effects, particularly when first starting or increasing the dose:
Bradycardia (slow heart rate)
Fatigue and weakness
Dizziness or lightheadedness
Nausea and stomach upset
Diarrhea
Cold hands and feet
Headache
Sotalol carries a boxed warning for pro-arrhythmic risk. Seek emergency care immediately if you experience:
Torsade de pointes / ventricular arrhythmia — fainting, rapid irregular heartbeat, loss of consciousness
Heart failure exacerbation — shortness of breath at rest, rapid weight gain, severe leg swelling
Severe bradycardia or AV block — extreme slowing of the heart rate, fainting
Bronchospasm — severe wheezing, difficulty breathing (especially dangerous in patients with asthma)
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Amiodarone (Pacerone, Cordarone)
Most effective antiarrhythmic; Class I/II/III/IV; used in structural heart disease; requires monitoring for thyroid, lung, and liver toxicity
Dronedarone (Multaq)
Amiodarone derivative with Class II+III properties; outpatient initiation possible; avoid in permanent AFib or significant heart failure
Dofetilide (Tikosyn)
Pure Class III potassium channel blocker; requires in-hospital initiation and REMS certification; renally dose-adjusted
Flecainide (Tambocor)
Class IC sodium channel blocker; for structurally normal hearts only; 'pill-in-the-pocket' option for paroxysmal AFib
Propafenone (Rythmol SR)
Class IC with mild beta-blocking; for structurally normal hearts; extended-release available
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Dofetilide (Tikosyn)
majorContraindicated — additive QT prolongation creates unacceptable risk of torsade de pointes
Fingolimod (Gilenya)
majorContraindicated — additive bradycardia, AV block, and QT prolongation
Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, moxifloxacin)
majorAdditive QT prolongation; avoid or use with close ECG monitoring
Azithromycin (Z-pack)
majorAdditive QT prolongation; increased risk of torsade de pointes
Verapamil / Diltiazem
majorAdditive bradycardia and AV block; potentially causing complete heart block
Antacids (aluminum/magnesium)
moderateReduces sotalol absorption by up to 25%; take at least 2 hours apart
Digoxin
moderateAdditive AV node slowing; increased risk of bradycardia and AV block
Loop and thiazide diuretics
moderateCan deplete potassium and magnesium, increasing risk of sotalol-induced QT prolongation and TdP
Sotalol is an effective and well-established antiarrhythmic medication for both atrial fibrillation and serious ventricular arrhythmias. Its dual Class II/III mechanism makes it uniquely suited for patients who need both rate control and rhythm stabilization. For patients on generic tablets, the medication is widely available and very affordable.
The main access challenges in 2026 relate to the oral solution (Sotylize), which continues to experience intermittent supply disruptions. Patients and providers who rely on the oral solution should plan ahead, maintain a backup compounding pharmacy relationship, and search broadly before running out.
If you're having trouble locating sotalol at your pharmacy, medfinder contacts pharmacies near you to find which ones can fill your prescription — no hold music, no repeated explanations. Results are texted directly to you. Never stop sotalol abruptly; always consult your cardiologist if you're having trouble accessing your medication.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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