Establishing an intravenous sotalol loading program

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia seen clinically with serious sequelae of stroke and heart failure as well as an independent risk factor for increased mortality. The latest guidelines for AF management recommend restoration and maintenance of normal sinus rhythm through the use of antiarrhythmic drugs, cardioversion, or catheter ablation treatment early after AF diagnosis to lower the risk of adverse cardiovascular outcomes. Intravenous (IV) sotalol loading for atrial arrhythmias allows for rapid achievement of the maximum plasma concentration steady state, where patients receive a 60-minute infusion, followed by 2 oral doses of the drug. Practical questions remain about establishing an IV sotalol program. While IV sotalol is not a new medication, the expanded indication for use of a loading dose requires pharmacy and therapeutics committee review of published data, such as indication, dosage, plans for patient and corrected QT monitoring, electrolyte monitoring and replacement, if necessary, order set and protocol development, and a timeline for the infusion process. The purpose of this article is to describe development of an IV sotalol loading program that addresses formulary approval, order set and protocol tips, and preadmission and admission considerations, including monitoring corrected QT intervals, staffing, and locations for the IV sotalol infusion process.