What is the difference between sotalol and atenolol

Select Format Select format. Permissions Icon Permissions. Abstract In order to dissociate the Class III effects of sotalol on QT interval and arrhythmias from those of chronic beta-receptor blockade, we compared the effects of sotalol mg b. Issue Section:. You do not currently have access to this article. Download all slides. Sign in Don't already have an Oxford Academic account? You could not be signed in. Sign In Forgot password?

Don't have an account? European Society of Cardiology members Sign in via society site. Sign in via your Institution Sign in. Purchase Subscription prices and ordering for this journal Short-term Access To purchase short term access, please sign in to your Oxford Academic account above. This article is also available for rental through DeepDyve. A systematic review which included 15 studies with a follow-up period ranging from one to seven years found that beta-blockers in patients with COPD significantly decreased overall mortality and exacerbation of COPD.

Cardioselective beta-blockers, e. Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing the blood brain barrier. Table 2: Summary of indications, recommendations and considerations for the use of beta-blockers for cardiovascular conditions in New Zealand. All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred.

Celiprolol and pindolol tend not to be used. Celiprolol and pindolol have ISA which may reduce bradycardia or peripheral vasoconstriction. Water soluble beta-blockers, e. Polypharmacy: bisoprolol is less likely to interact with other medicines. Renal dysfunction: consider dose adjustments for water-soluble beta-blockers, e. Respiratory disease: cardioselective beta-blockers, e. Bisoprolol or metoprolol; consider withdrawal after 6—12 months if re-vascularised and no other indications. Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite.

Occasionally it may be necessary to temporarily withdraw treatment, e. In the long-term, the emergence of co-morbidities may make management more complex and it is appropriate to periodically review the benefits and risks of treatment with beta-blockers. Beta-blockers should be withdrawn slowly to prevent the onset of a withdrawal syndrome which in serious cases may include ischaemic cardiac symptoms, e.

The risk of myocardial infarction is increased for older patients during the first month of withdrawal from cardioselective beta-blockers and this increased risk continues for six months. There are no specific guidelines for withdrawing beta-blockers.

The dose could be halved every week for patients who needed to withdraw from treatment more rapidly. We have now added the ability to add replies to a comment.

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Made with by the bpac nz team. Prescribing Reports. CME Quizzes. Peer Group Discussions. My Bpac account. Search Mybpac - Login. Latest Articles View Articles. Prescribing Reports View reports. Audits View all audits. Peer Group Discussions View all discussions. Hello there! Remember me. This item is 4 years and 4 months old; some content may no longer be current. Cardiovascular system Medicine indications Pharmacology. Beta-blockers for cardiovascular conditions: one size does not fit all patients Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand.

Please login to save this article. Log in. Key practice points: Beta-blockers are a diverse group of medicines and prescribers should consider their different properties, along with the presence of co-morbidities, to individualise care for patients with cardiovascular conditions When a beta-blocker is initiated, a slow upwards titration of dose is recommended to minimise adverse effects.

Beta-blockers should also be withdrawn slowly, ideally over several months, to prevent rebound symptoms such as resting tachycardia. From months onwards post-myocardial infarction, consider withdrawing beta-blockers for patients without heart failure or arrhythmias, if re-vascularisation has occurred Bisoprolol is an alternative to metoprolol succinate in many cases; both are once-daily cardioselective beta-blockers that are less likely to cause fatigue and cold extremities than non-specific beta-blockers and are often preferred for patients with co-existing chronic obstructive pulmonary disorder COPD because they cause less bronchoconstriction.

Reliance on one medicine may cause problems The recent disruption of the supply of metoprolol succinate where dispensing was limited to fortnightly or monthly amounts highlights the risk of depending on one beta-blocker.

Sick sinus syndrome. Sinus bradycardia heart rate less than 60 beats per minute at the start of treatment. Severe hypotension systolic less than mmHg. Severe peripheral arterial disease pain at rest and sometimes intermittent claudication — the blood pressure-lowering properties of beta-blockers can exacerbate symptoms. Uncontrolled heart failure. Seek specialist advice before starting a beta-blocker in people with a current or recent exacerbation of heart failure.

Beta-blockers should be used with caution in people with: Diabetes. First-degree atrioventricular AV block. Myasthaenia gravis. Portal hypertension — due to risk of deteriorating liver function. Note: Be aware that use of a beta-blocker can mask symptoms of hypoglycaemia and thyrotoxicosis. Adverse effects of beta-blockers include: Bradycardia. Cold extremities, paraesthesiae, and numbness — these are more common in people with peripheral vascular disease.

If troublesome, beta-blockers might need to be stopped. Conduction disorders. Exacerbation of psoriasis. It is also only used by patient who paroxysmal or persistent AF to help maintain sinus rhythm. There are some reports of this drug causing liver damage, so when you first start taking it you have a blood test to check your liver function.

This will happen every month for the first six months of your treatment, then at nine months. You will then have another at 12 months and then at certain intervals after that. You will also have a blood test seven to ten days after starting the drug to check your kidney function. You will also have an ECG at least every six months. If your ECG shows that you have remained in persistent AF, this indicates that the medication is not working as it should and you will need to stop taking it.

Side effects should stop within the first two weeks of starting dronedarone. But for some patients, we will tell them to stop taking because of the side effects. Dronedarone can interact with many medications and herbal medicines. So you must make your GP and pharmacist aware of all the medicines you are taking including herbal products. It can also increase the circulating levels of these drugs in the body.

You may find that your GP is unable to continue to provide you with further supplies of dronedarone tablets. Your GP may prescribe dronedarone for you if they have an agreement from the hospital, known as a shared care document. This details the responsibilities of both the GP and the hospital. If you are having difficulties obtaining a regular supply of your tablets, please contact Sally Manning , senior arrhythmia pharmacist. Atrial fibrillation is an abnormal heart rhythm. It is the most common heart rhythm disorder in the UK.

Sally Manning Zainab Khanbhai. Harefield Hospital: Royal Brompton Hospital: You are here:. Home Our services Atrial fibrillation medications. Search: name, specialism, conditions, treatments, tests or services. Overview Related conditions Information Antiarrhythmic medications work by helping to stabilise electrical impulses within the heart.

These are the common medications we use to treat atrial fibrillation. Dose The dose you will need to take will depend on what kind of beta blocker we prescribe.

Side effects Fatigue The most common side effect that people experience when taking beta blockers is fatigue and tiredness. Breathlessness Beta-blockers sometimes affect the lungs and cause breathlessness. Light-headedness As beta-blockers reduce your heart rate and blood pressure they can sometimes make you feel dizzy and lightheaded. Cold hands and feet Beta blockers can affect the circulation and make your hands and feet cold.

Dose You would normally start on a low dose of these and the increase them if you need to. Monitoring This will usually be done one to two weeks after starting the medication.

Side effects The most common side effects patients who take this kind of medication have are feeling flushed and light-headed. Light-headedness This medication can cause a drop in BP for some patients, meaning they experience some light-headedness or dizziness. Ankle swelling You may find that your ankles become swollen with this medication. Heart failure If you know that you have severe heart failure known as left ventricular impairment you should not use verapamil or diltiazem.

If you notice any of the following you should contact your GP as soon as possible: Any difficulties breathing, new breathlessness on exertion Severe ankle swelling Digoxin Digoxin is a medication extracted from foxglove plants and is used to treat AF.

Dose You would take this medication once a day but may need to take a higher 'loading' dose initially. Monitoring You would only need your Digoxin intake monitored if your doctor feels that the dosage is too low or if you are having side effects. Side effects This medication is usually well tolerated by those taking it but if your dose is too high, you may start to show signs of toxicity.

This includes: loss of appetite nausea vomiting diarrhoea blurred vision visual disturbances yellow-green halos around people or objects, some have described these as auras confusion drowsiness dizziness If you think that your digoxin is causing problems, get medical attention for it.

If your symptoms do not improve and you feel very unwell, you should call an ambulance. Flecainide Flecainide is a sodium channel-blocking drug, which slows the conduction carrying the electrical impulses within the heart.

This drug is only given to people who have a normal functioning heart. Dose When you start taking flecainide, you will start on a low dose 50mg twice a day , with possibly going up to mg twice a day. Monitoring Once you start taking flecainide you will need to have regular ECGs. Side effects The most common side effect of flecainide is visual disturbances. Sotalol Sotalol is a mixture of a beta-blocker and an anti-arrhythmic.

Dose You will start on a low dose 40mg twice a day and can go up to mg twice a day. Monitoring When you start taking sotalol you will need to have regular ECGs. It is especially important that we check this when your heart is in sinus rhythm. You will usually have an ECG about one week after starting sotalol and after each dose increase. Side effects The most common side effect with sotalol is bradycardia when the heart beats at a slow rate, usually less than 60 beats per minute.

Other side effects, which are associated with beta blockers, include: fatigue or tiredness cold extremities cold hands and feet exacerbation of asthma light-headedness. Amiodarone This drug works in a similar way to sotalol by blocking potassium channels and slowing conduction within the heart.

Dose You will start this medication either with a tablet or by intravenous injection over 24 hours.