Oral Propranolol for Hemangiomas of Infancy

Marcia L. Buck, Pharm.D., FCCP, FPPAG

Disclosures

Pediatr Pharm. 2010;16(8) 

In This Article

Abstract and Introduction

Introduction

In the June 12, 2008 issue of The New England Journal of Medicine, Christine Léauté-Labréze and colleagues from the Bordeaux Children's Hospital reported their preliminary experience with propranolol in the treatment of severe hemangiomas of infancy.[1] Their brief Letter to the Editor described 11 infants with capillary hemangiomas: ten with facial lesions and one a hemangioma on the forearm. The first four infants had failed to respond to prednisolone. Average age at the onset of therapy was 3.2 months (range 2–6 months). The first patient was treated with an oral propranolol dose of 3 mg/kg/day, while the remaining patients received 2 mg/kg/day. All patients demonstrated improvement in the size and color of their hemangiomas, with ultrasound confirmation of a reduction in size available in four of the infants. The average duration of treatment in the ten patients who had completed therapy at the time of publication was 9.8 months. At follow-up, seven of the ten infants who completed treatment continued to have regression in the color and thickness of their lesions while the others remained stable.

The effectiveness of a commonly used, older drug for this condition was unexpected. It provided clinicians with an alternative to drugs with more significant adverse effect profiles (corticosteroids, interferon alfa, cyclophosphamide, and vincristine) and quickly became a first-line therapy. Propranolol, approved by the Food and Drug Administration on November 13, 1976, was the first beta-adrenergic receptor-blocking agent introduced in the United States and has been used in a wide variety of disease states.[2,3] This issue of Pediatric Pharmacotherapy will provide a brief review of the pharmacology of propranolol and focus on recent case reports of its use in treating infantile hemangiomas.

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