Sotalol vs metoprolol

I had been on metoprolol since My afib diagnosis about three years ago. Since my heart started stopping for seconds at a time, I had a pacemaker implant about two years ago.  I felt I was doing fine, and so did my cardiologist. About six months ago, my cardiologist left, and I can't get in with a new one until December.  An electrophysiologist in the same practice called me about three months ago and said he was switching me from metoprolol to Sotalol. Since then, I have had spells of being lightheaded, and had a lack of energy.  I did see a nurse practitioner in cardiology, and she cut the dose of sotalol from 160 mg a day to 80 mg a day. The symptoms improved slightly, but it was still affecting my daily activities. I am now on only 40 mg a day, and again it is better, but not as good as the metoprolol. Although the electrophysiologist preferred for me to take sotalol, I think I'm going to go back to the metoprolol.

has anyone had experience with either of these drugs?

6 Comments

Re: Sotalol vs Metoprolol

by H van Dyk - 2024-07-09 16:51:49

The same happened more or less to me after my pacemaker was installed (March 2023). The cardiologist in the hospital notified me that I had to switch from Metaprolol over to Carvedilol. When I asked about the reason, he simply stated that this medication was even better. End of conversation, lol....
I have to say that the switch went smooth and never caused any problems. I take 12,5 mg twice a day. You might want to check with your medical team if this medicine is an option for you too, or ask them if it's okay to go back to Metaprolol. Be careful with self-medicate !

Choice

by doublehorn48 - 2024-07-09 18:15:09

Have you tried conracting the EP about the side effects? It seems that the side effects of Sotalol are unacceptable. I would try to get some explanation as to why you shouldn't take Metoprolol. 

Sota & Meto

by Daedalus - 2024-07-09 18:16:00

When first diagnosed with Afib in early '22, my cardiologist/EP set me up with Metoprolol, 12.5 mg daily.  Two weeks later at a follow up  appointment, I mentioned that it caused my HR to progressively drop until it was 40.  She said to stop taking it.  Three days later another bad AF episode and went to ER.  Saw her again at hospital and we discussed the options.  Decided on a pacemaker (set at 60) and Sotalol.  Started at 40mg bid, then upped it to 80mg bid.  So far tolerating it fine and the AF episodes minimal.  
Be sure to check with the doctor before attempting to switch meds.  Remember that Sotalol has to be initiated in a hospital setting that has cardio resuscitative capabilities.  
Good luck to you and I hope you find a satisfactory solution!

Sotalol can be an effective medication for Atrial Fibrillation but Metoprolol alone is probably safer

by Gemita - 2024-07-09 18:57:46

Mathbev, no direct experience, although I was offered Sotalol at the start of my Atrial Fibrillation (AF) journey but declined choosing a beta blocker (Bisoprolol) initially instead for rate control only. 

It should be remembered that Sotalol is stronger and more likely to cause symptoms than Metoprolol alone because Sotalol is both an anti arrhythmic medication AND a beta blocker all in one tablet.  In the UK, I was not told that I would need to be hospitalised for Sotalol initiation, although I realise this is sometimes recommended.

If you feel you were doing fine on Metoprolol and with your pacemaker, I would respectfully ask your new electrophysiologist if you could remain on Metoprolol for the foreseeable future.  I hope like me, you will find a beta blocker + pacemaker an adequate treatment for your AF without resorting to stronger, potentially more dangerous meds.

Good luck

Sotalol and Metoprolol

by Julros - 2024-07-09 21:44:23

I was on both meds concrrently  for 2 years, and during that time gained about 40 pounds. Note, I was taking metroprolol succinate. I started the sotalol during the pandemic, so I didn't stay in hospital, but I did get a 12 lead EKG daily, 2 hours after my morning dose, for 3 days in a row. I had a cardioversion 2 weeks later, which lasted 1 day. I later had an afib and aflutter ablation, a cardioversion at the same time, resulting in sinus rhytthm. 

I stopped sotalol in February. My EP offered to start amiodorone, which I declined. She warned me that I would likely go into permanent Afib. I have remained in sirus rhythm. 

Not a Fan of Sotalol

by DoingMyBest - 2024-07-10 01:48:01

MATHBEV, my experience was similar but somewhat reversed from yours. Solalol was the first medication tried on me 10 years ago. I did not do well with it at all. After they switched me to Metoprolol, I did fine with it for several years. I was then on Flecainide Acetate for a couple years, and that seemed to work okay too. But, after an ablation and pacemaker implant a year ago, I'm now back on low-dose metoprolol and all is well.

I'd rather not try Sotalol again unless my symptoms flair up and other drugs don't work.

You know you're wired when...

You participate in the Pacer Olympics.

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