Rapid intravenous administration of high-dose d-sotalol can induce severe QT prolongation and torsades de pointes, highlighting the critical importance of dosage and infusion rate.
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May caution against rapid high-dose d-sotalol IV; case report leaves open safe administration protocols.
A patient with heart failure was administered d-sotalol 3.0 mg/kg infused over 2 minutes. The patient had normal electrolytes and baseline QT. Six minutes after drug administration the QT prolonged to 600 msec, and the patient developed torsades de pointes and required electrical cardioversion. This emphasizes the need to consider both rate of administration and the dosage when evaluating the safety and efficacy of a new class III antiarrhythmic drug.
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Gottlieb et al. (1997) studied this question.
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