Drug interactions
Esmolol + Sotalol
Severity: Major
Esmolol and Sotalol: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Sotalol has non-selective beta-blocking and class III antiarrhythmic activity, so esmolol adds duplicate beta-blockade. The combination increases the risk of severe bradycardia, hypotension and AV block, and sotalol's QT prolongation may be unmasked if bradycardia develops.
What this interaction means in plain words
Esmolol and Sotalol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Esmolol belongs to Cardiovascular; Sotalol belongs to Cardiovascular.
Why it happens
Additive beta-adrenergic blockade, with sotalol's QT-prolonging effect worsened by bradycardia.
What to do
Avoid combining unless closely monitored in a setting with continuous ECG and blood pressure monitoring. Reduce or stop esmolol if bradycardia, hypotension or QT prolongation occurs.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Esmolol
- Acebutolol + Esmolol Major
- Amifostine + Esmolol Major
- Amiodarone + Esmolol Major
- Celiprolol + Esmolol Major
- Diltiazem + Esmolol Major
- Epinephrine racemic + Esmolol Major
Other interactions of Sotalol
- Arsenic trioxide + Sotalol Contraindicated
- Artemether / lumefantrine + Sotalol Contraindicated
- Disopyramide + Sotalol Contraindicated
- Dofetilide + Sotalol Contraindicated
- Dronedarone + Sotalol Contraindicated
- Droperidol + Sotalol Contraindicated
Frequently asked questions
Can I take Esmolol with Sotalol?
MediHelp rates the interaction as major. Esmolol and Sotalol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Sotalol has non-selective beta-blocking and class III antiarrhythmic activity, so esmolol adds duplicate beta-blockade. The combination increases the risk of severe bradycardia, hypotension and AV block, and sotalol's QT prolongation may be unmasked if bradycardia develops.
How serious is the interaction between Esmolol and Sotalol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combining unless closely monitored in a setting with continuous ECG and blood pressure monitoring. Reduce or stop esmolol if bradycardia, hypotension or QT prolongation occurs.
What other medicines interact with Esmolol?
MediHelp also lists interactions of Esmolol with, for example, Acebutolol, Amifostine, Amiodarone. The full list is on the Esmolol page.
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