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Comparative beta-blocking activities and electrophysiologic actions of racemic sotalol and its optical isomers in
Abstract:
The relative activities of d-, 1- and racemic-sotalol were studied in two series of anesthetized dogs. Estimates of relative beta-adrenergic blocking potency were based upon the ability of the compounds to antagonize isoproterenol-elicited increases in heart rate and decreases in diastolic blood pressure. On a molar basis, d-sotalol displayed 1/12-1/14th and 1-sotalol 1.6-3.2 X the potency of the racemic parent drug as beta-antagonists. His bundle electrogram (HBE) measurements, surface ECG recordings and the extra stimulus technique at a constant pacing cycle length were utilized to assess the comparative effects of sotalol and its optical isomers on cardiac conduction and refractoriness. At i.v. doses spanning equiactive beta-blocking levels, d- (1, 4, 16 mg X kg-1), 1- (0.25, 1, 4 mg X kg-1) or dl-sotalol (0.5, 2, 8 mg X kg-1) caused dose-dependent increases in ventricular and, to an even greater extent, atrial refractoriness. The mean plasma drug concentrations (Cp) attained with these doses were: d-sotalol 9.5, 44 and 267 nmol X l-1; 1-sotalol 9.6, 16 and 66 nmol X l-1; and dl-sotalol 5.4, 23 and 106 nmol X l-1. The relative mg potency from greatest to least was 1-sotalol greater than dl-sotalol greater than d-sotalol in prolonging the ventricular effective refractory period (V-ERP); the mean increases above control at the highest dose of each were 58 +/- 4, 47 +/- 6 and 38 +/- 3 ms, respectively. At those same dose levels, atrial refractoriness (A-ERP) was maximally elevated 49 +/- 11, 82 +/- 5 and 104 +/- 10 ms by 1-, dl- and d-sotalol, respectively. These increases in refractoriness occurred without alterations in atrial, His-Purkinje or ventricular conduction velocity; however, all three forms of sotalol significantly reduced AV nodal conduction. At the dose multiples studied, the effects on this variable (AH interval) were greatest following 1-sotalol (20-60 ms) or racemic sotalol (20-57 ms) and least following the d-isomer (7-43 ms). The profile of effects observed with d-sotalol is that of an agent with Class III electrophysiologic effects and weak beta-adrenergic blocking properties.