There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
solution
Tablet
CAUTIONARY AND ADVISORY LABELS 8
▶Sotalol hydrochloride (Non-proprietary)
Sotalol hydrochloride 40 mg Sotalol 40mg tablets |
28 tablet P £1.26 DT = £1.24
Sotalol hydrochloride 80 mg Sotalol 80mg tablets |
28 tablet P £3.75 DT = £1.32 | 56 tablet P £2.83
Sotalol hydrochloride 160 mg Sotalol 160mg tablets |
28 tablet P £5.95 DT = £4.87
▶Beta-Cardone (Advanz Pharma)
Sotalol hydrochloride 200 mg Beta-Cardone 200mg tablets |
28 tablet P £2.40 DT = £2.40
▶Sotacor (Cheplapharm Arzneimittel GmbH)
Sotalol hydrochloride 80 mg Sotacor 80mg tablets |
30 tablet P £3.28
CARDIAC GLYCOSIDES
Cardiac glycosides
Digoxin-specific antibody
Serious cases of digoxin toxicity should be discussed with the
National Poisons Information Service (see further
information, under Poisoning, emergency treatment
p. 1430). Digoxin-specific antibody fragments p. 1440 are
indicated for the treatment of known or strongly suspected
life-threatening digoxin toxicity associated with ventricular
arrhythmias or bradyarrhythmias unresponsive to atropine
sulfate p. 1404 and when measures beyond the withdrawal of
digoxin below and correction of any electrolyte
abnormalities are considered necessary.
Digoxin
Digoxin is most useful for controlling ventricular response in
persistent and permanent atrial fibrillation and atrial flutter.
Digoxin also has a role in heart failure.
For management of atrial fibrillation the maintenance
dose of digoxin can usually be determined by the ventricular
rate at rest, which should not usually be allowed to fall
persistently below 60 beats per minute.
Digoxin is now rarely used for rapid control of heart rate
(see management of supraventricular arrhythmias). Even
with intravenous administration, response may take many
hours; persistence of tachycardia is therefore not an
indication for exceeding the recommended dose. The
intramuscular route is not recommended.
In patients with heart failure who are in sinus rhythm a
loading dose is not required, and a satisfactory plasma-
digoxin concentration can be achieved over a period of about
a week.
Digoxin has a long half-life and maintenance doses need
to be given only once daily (although higher doses may be
divided to avoid nausea); renal function is the most
important determinant of digoxin dosage.
Unwanted effects depend both on the concentration of
digoxin in the plasma and on the sensitivity of the
conducting system or of the myocardium, which is often
increased in heart disease. It can sometimes be difficult to
distinguish between toxic effects and clinical deterioration
because symptoms of both are similar. The plasma
concentration alone cannot indicate toxicity reliably, but the
likelihood of toxicity increases progressively through the
range 1.5 to 3 micrograms/litre for digoxin. Digoxin should
be used with special care in the elderly, who may be
particularly susceptible to digitalis toxicity.
Regular monitoring of plasma-digoxin concentration
during maintenance treatment is not necessary unless
problems are suspected. Hypokalaemia predisposes the
patient to digitalis toxicity; it is managed by giving a
potassium-sparing diuretic or, if necessary, potassium
supplementation.
If toxicity occurs, digoxin should be withdrawn; serious
manifestations require urgent specialist management.
Digoxin-specific antibody fragments are available for
reversal of life-threatening overdosage.
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