Sotalol

Sotalol

L isomer has predominantly beta blocker effect while the D isomer has predominantly Class III effect. If D-sotalol is being used, beta blocker may to be added for better effect. This was one of the criticisms on SWORD trial which showed higher mortality with D-sotalol, which was presumably arrhythmic [1].

Reference

1. A L Waldo, A J Camm, H deRuyter, P L Friedman, D J MacNeil, J F Pauls, B Pitt, C M Pratt, P J Schwartz, E P Veltri. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol. Lancet. 1996 Jul 6;348(9019):7-12.