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Betapace (sotalol hydrochloride) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat documented, life-threatening heart rhythm problems that start in the lower chambers of the heart (ventricular arrhythmias).

What Members Say

MHT logoThese insights are based on 68 comments about Betapace from MyHeartDiseaseTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:
  • Many members said Betapace helped keep their heart rhythm regular or reduced atrial fibrillation episodes.

  • Some members said Betapace helped maintain a normal sinus rhythm after cardioversion or ablation.

  • Several members described having more energy, less shortness of breath, or fewer palpitations when their heart rhythm improved.

Considerations:
  • Starting or restarting Betapace often requires at least a three-day hospital stay with electrocardiogram (ECG) monitoring.

  • Fatigue is a frequently reported downside and is listed in prescribing information.

  • Some members said rhythm control became less effective over time or did not fully prevent recurrences.

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How Betapace Works and How It’s Taken

Betapace is a type of medication called an anti-arrhythmic. It helps control the heart’s rhythm by blocking certain signals that affect heart rate and changing how electrical signals move through the heart. This helps slow the heart rate and control abnormal heart rhythms.

Doctors prescribe Betapace when people have documented, life-threatening ventricular arrhythmias. They also prescribe it to help delay the return of atrial fibrillation or atrial flutter in people who have significant symptoms and whose heart rhythm has already returned to normal.

Betapace comes as a tablet taken by mouth. How often it is taken depends on the condition being treated and how well the kidneys work.

Typical Dosing for Heart Rhythm Problems

The recommended starting dose of Betapace for adults is 80 milligrams twice daily.

If needed, a doctor may increase the dose by 80 milligrams per day every three days, as long as tests show that the medicine is not causing certain unsafe changes in the heart’s electrical activity.

For most adults with life-threatening ventricular arrhythmias, the total daily dose is 160 to 320 milligrams, divided into two or three doses. Higher doses have been used for some people with serious heart rhythm problems that are difficult to treat.

For adults taking Betapace to help prevent the return of atrial fibrillation or atrial flutter, most people respond well to 120 milligrams twice daily.

People with reduced kidney function may need lower doses or more time between doses.

Treatment must be started or restarted in a hospital or another healthcare facility where the heart can be monitored continuously for at least three days or until the medicine reaches a steady level in the body.

Your healthcare provider will decide the right dose based on your condition, kidney function, and heart tests. Do not change or stop taking Betapace without medical advice.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

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Top Advice From Members on Betapace

MHT logoThese insights are based on 68 comments about Betapace from MyHeartDiseaseTeam members. They reflect the experiences of a small number of people and are not meant to be medical advice.
 

Members who use Betapace often discuss the importance of close follow-up, especially when starting the medication or adjusting the dose. They also frequently mention watching for fatigue, taking doses consistently, and talking with a heart rhythm specialist about whether Betapace, ablation, or both fit into their treatment plan.

  1. 1
    Expect hospital monitoring when starting Betapace.
    “My electrophysiologist started me on Betapace, an anti-arrhythmic, which required a three-day hospitalization.”
  2. 2
    Tell your doctor if fatigue is affecting daily life.
    “Betapace makes me very tired, although it does control my heart rate.”
  3. 3
    Talk to your doctor about dose changes and follow-up.
    “My electrophysiologist raised my sotalol to 120 milligrams twice daily from 80 milligrams. Hope this does the trick.”

Connect with others who understand life with heart disease. Join MyHeartDiseaseTeam for free.

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Betapace Side Effects

In clinical studies of sotalol, the most common side effects occurred in about 3 percent to 20 percent of people, depending on the side effect, dose, and study population. These include:

  • Fatigue
  • Dizziness
  • Dyspnea (shortness of breath)
  • Bradycardia (slow heart rate)
  • Proarrhythmia (new or worsening abnormal heart rhythms)
  • Hyperhidrosis (increased sweating)
  • Asthenia (weakness)

Serious Side Effects and Warnings

Betapace can cause serious side effects that may require immediate medical attention. These include:

  • QT prolongation and dangerous heart rhythm problems — Changes in the heart’s electrical timing can trigger life-threatening rhythms, including Torsade de Pointes.
  • Hypotension (low blood pressure) — Blood pressure may drop while taking Betapace.
  • New or worsening heart failure — The heart may not pump as well, especially when starting treatment or increasing the dose.
  • Bronchospasm (tightening of the airways) — This can worsen breathing problems such as asthma, chronic bronchitis, or emphysema.
  • Low blood sugar or changes in blood sugar control — Symptoms of low blood sugar may be harder to notice, especially if you have diabetes.
  • Worsening thyroid symptoms after abruptly stopping Betapace — Suddenly stopping beta-blockers can worsen symptoms of an overactive thyroid.
  • Anaphylaxis (severe allergic reaction) — An allergic reaction may be harder to treat while taking a beta-blocker.

Get medical help right away if you think you are having a serious reaction.

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How To Save on Betapace

Legacy Pharma offers the Legacy Patient Program, which provides eligible uninsured and underinsured people in the United States with Betapace at no cost for up to 12 months per calendar year, subject to prescription, income, residency, and insurance requirements.

You can enter your prescription and dosage details through the program’s online registration portal.

To learn more or apply, visit the Legacy Patient Program website or call 866-435-8080.

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What To Know Before Taking Betapace

Before starting Betapace, your doctor will check:

  • Your heart’s electrical activity using an electrocardiogram (ECG). This test measures the QT interval, which shows how long your heart takes to reset between beats.
  • Your potassium and magnesium levels. Low levels must be corrected before treatment.
  • Your kidney function through blood tests to help determine the right dosing schedule.

Tell your doctor if you are allergic to sotalol or have had an allergic reaction to Betapace.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Avoid taking Betapace within two hours of antacids that contain aluminum oxide or magnesium hydroxide.

Do not take Betapace if you have:

  • A very slow heart rate (sinus bradycardia), certain types of heart block, or sick sinus syndrome, unless you have a working pacemaker
  • Long QT syndrome, a condition that affects the heart’s electrical activity
  • A potassium level below 4 milliequivalents per liter
  • Cardiogenic shock, a condition in which the heart cannot pump enough blood to the body
  • Decompensated heart failure (heart failure that has become worse)
  • Asthma or similar conditions that cause the airways to narrow
  • An allergy to sotalol

If you are taking Betapace for atrial fibrillation or atrial flutter, you should also not take it if your QT interval is longer than 450 milliseconds.

If you miss a dose, take your next dose at the usual time. Do not take two doses at once or take your next dose earlier than scheduled.

If you are pregnant or planning to become pregnant, talk with your doctor about the possible risks of Betapace.

Do not breastfeed while taking Betapace because the medicine passes into breast milk and may cause serious side effects in your baby.

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Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Betapace for heart rhythm problems?

Clinical studies of sotalol found that it helped delay the return of atrial fibrillation or atrial flutter, which are conditions that cause an abnormal heart rhythm.

In one 12-month study, the median (middle) time until symptoms returned was:

  • Placebo (an inactive treatment) — 27 days
  • 80 milligrams of sotalol — 106 days
  • 120 milligrams of sotalol — 229 days
  • 160 milligrams of sotalol — 175 days

These doses were generally taken twice daily. Some people with reduced kidney function took them once daily.

In another six-month study involving people with long-lasting atrial fibrillation, the median time until the abnormal heart rhythm returned or death occurred was 44 days with placebo and more than 180 days with sotalol.

Not everyone stayed on treatment. In the 12-month study, people taking higher doses were more likely to stop treatment because of side effects.

How long does Betapace take to work for heart rhythm problems?

After taking Betapace by mouth, the medicine usually reaches its highest level in the blood within 2.5 to 4 hours.

When taken twice daily, the medicine usually reaches a steady level in the blood within two to three days, or after about five to six doses.

However, this does not mean that everyone will notice an improvement in their heart rhythm symptoms within that time. The prescribing information does not give an exact time for when symptoms may improve.

Does Betapace interact with other medicines?

Yes. Betapace can interact with other medicines. Some interactions may increase the risk of serious side effects or affect how well the medicine works.

Medicines that may interact with Betapace include:

  • Other heart rhythm medicines — Drugs such as amiodarone, quinidine, and procainamide may increase the risk of dangerous changes in heart rhythm. Taking Betapace with other medicines that prolong the QT interval should be avoided.
  • Medicines that slow the heart rate — Digoxin, diltiazem, verapamil, and other beta-blockers may increase the risk of a slow heart rate or low blood pressure.
  • Diabetes medicines — Betapace may affect blood sugar levels. People taking insulin or other diabetes medicines may need dose adjustments.
  • Asthma medicines — Medicines such as albuterol and terbutaline may require higher doses when taken with Betapace.
  • Clonidine — Taking clonidine with Betapace may increase the risk of a slow heart rate or problems with the heart’s electrical signals.
  • Certain antacids — Antacids containing aluminum oxide or magnesium hydroxide can reduce how much Betapace the body absorbs. Avoid taking Betapace within two hours of these antacids.

Tell your doctor about all the medicines you take. Do not start taking any new medicine without talking to your doctor first.

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