PHARMACOKINETIC EVALUATION OF A CASE OF MASSIVE SOTALOL INTOXICATION

OBJECTIVE: To describe serum concentrations and clearance of sotalol a fter a massive overdose. CASE SUMMARY: A 37-year-old white man took 11 .2 g of sotalol hydrochloride tablets in a suicide attempt, The first serum d,l-sotalol concentration 3 hours after taking the first tablet was 20.6 mg/L and the last measured concentration 59 hours later was 1 .8 mg/L. Logarithmic transformation of the concentration data indicate d two separate monoexponential phases in the elimination curve, with h alf-lives of 30.1 and 11.6 hours. DISCUSSION: The shorter serum half-l ife in the later phase is comparable with that in four previously repo rted sotalol intoxications and within the normal range. The eliminatio n rate increased in a temporal manner with an increase in systolic blo od pressure about 30 hours after the patient was admitted. Since the s otalol elimination rate depends principally on renal function, we beli eve the initially slow elimination is due to a temporary reduction of the renal function caused by the systolic hypotension. CONCLUSIONS: An initial phase of slow sotalol elimination may occur after severe over doses. In our patient this was probably due to hypotension. Thus, bloo d pressure should be monitored carefully.