Hi, Pauline:  Boy, my heart really goes out to this young mom.  I'm
assuming she has some kind of atrial arrhythmia going on?  Atrial
fibrillation, maybe?  The trade name of sotalol is Beta-pace, which is a
pretty powerful anti-arrhythmic.  Hale lists it as an L3 (B during
pregnancy).  The molecular weight is 272, so probably passes pretty easily
into milk, and not surprisingly, there are concerns related to bradycardia
and hypotension in the baby as well as sedation.
I don't know that this mom's cardiologist should go so far as to tell her
the baby will drop dead within 3-5 minutes of nursing, but bradycardia in
the baby is a distinct possiblity.
When a patient is started on sotalol, it's done on a telemetry unit in the
hospital for 3-4 days so that the patient can be continuously monitored for
things like bradycardia.  It's also recommended that if the doseage needs
to be changed during treatment, the patient be rehospitalized, again, for
continuous monitoring while the doseage is adjusted.
How do I know all this?  Been there, done that, myself.  Fortunately my
heart issues developed after I was done nursing babies, but none of this is
fun.  I have been on virtually all the anti-arrhythmics that are currently
on the market, neccessitating several hospitalizations, the last one in the
ICU for 4 days while I was put on the medication of last resort
(dofetilide - trade name Tikosyn).  Thank God this one works, most of the
time, but it's a pretty scary drug.  A nurse here at the hospital asked me
why I would take such a dangerous drug.  Because it works for me!
The only anti-arrhythmic that appears safe for nursing is digoxin, but I'm
assuming this mom has already tried this medication with no success.  It's
usually the 1st one they try.
Good luck to all involved in this situation.

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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