Olanzapine with Sotalol Interaction Details
Brand Names Associated with Olanzapine
- Olanzapine
- Symbyax® (as a combination product containing Fluoxetine, Olanzapine )
- Zyprexa®
- Zyprexa® Zydis
Brand Names Associated with Sotalol
- Betapace®
- Betapace® AF
- Sorine®
- Sotalol
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
An increased risk of QT interval prolongation
Interaction Summary
Avoid use of sotalol, a QT interval prolonging agent, with other drugs that are known to prolong the QT interval. There have been isolated reports of QTc prolongation and torsade de pointes temporally related to the concomitant administration of sotalol with the QT prolonging agent ciprofloxacin .
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Avoid use of sotalol, a QT interval prolonging agent, with other drugs that are known to prolong the QT interval.
Mechanism Of Interaction
Additive QT interval prolongation
Literature Reports
A) A 70-year-old female receiving sotalol therapy experienced torsade de pointes following coadministration of the QT prolonging agent ciprofloxacin. The patient was admitted with new onset atrial fibrillation with rapid ventricular response and was given IV amiodarone (loading dose, 450 mg; followed by 24-hour infusion, 650 mg) and digoxin (0.25 mg/day). The patient converted to sinus rhythm within 48 hours of admission. Both amiodarone and digoxin were discontinued and sotalol (40 mg twice daily) was initiated. The next day the patient presented with jaundice, fever, and cholecystitis, and was treated with IV ciprofloxacin 400 mg twice daily. Within 12 hours of ciprofloxacin administration, the patient developed syncope with documented torsade de pointes that necessitated defibrillation. Her QTc interval, which was 0.38 seconds prior to ciprofloxacin initiation, was significantly (0.62 seconds) increased following resuscitation. Within 3 days of ciprofloxacin and sotalol discontinuation, the QTc interval decreased to 0.42 seconds .
B) Torsade de pointes temporally related to the QT prolonging agent ciprofloxacin administration was reported in a 44-year-old female who was stable on sotalol 160 mg twice a day for the treatment of supraventricular arrhythmia. Pyelonephritis was treated with ciprofloxacin 1 g in the emergency room (ER). At that time, the QTc interval measured 405 milliseconds. The patient was discharged on ciprofloxacin 500 mg twice a day. Within hours of discharge, she experienced several presyncopal and syncopal episodes and returned to the ER. Torsade-induced syncope was diagnosed and defibrillation was required. The QTc interval following resuscitation was 590 milliseconds which was compared with previous normal or slightly increased intervals (maximum, 460 milliseconds) during sotalol maintenance therapy. Upon discontinuation of both medications, the QTc interval normalized within 2 days .
Olanzapine Overview
-
Olanzapine is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) in adults and teenagers 13 years of age and older. Olanzapine is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
Sotalol Overview
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Sotalol is used to treat irregular heartbeats. Sotalol is in a class of medications called antiarrhythmics. It works by acting on the heart muscle to improve the heart's rhythm.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.