Oral Propranolol for Hemangiomas of Infancy

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


Pediatr Pharm. 2010;16(8) 

In This Article

Dosing Recommendations

In a follow-up letter to the initial publication by Léauté-Labréze and colleagues, Siegfried, Keenan, and Al-Jurcidini first described a treatment protocol for oral propranolol in infants with hemangiomas.[13] General treatment guidelines have been developed based on their recommendations and those of subsequent authors.[1,4–12,15] Prior to the start of treatment, a complete family history should be obtained (with attention to cardiovascular disease), along with a thorough physical examination, serum chemistries, and a baseline assessment of heart rate and blood pressure. Most centers obtain a baseline ECG as well.

Therapy is typically initiated with a propranolol dose of 0.5–1 mg/kg/day (divided and given orally three times daily). If tolerated, the dose may be increased to 2–3 mg/kg/day. Treatment is typically continued for 6–12 months, with doses adjusted for weight gain on a monthly basis. At the conclusion of treatment, propranolol should be tapered off, with a 50% reduction in dose for 1–2 weeks prior to discontinuation.

All propranolol doses provided in the published case reports and case series, as well as in this review are for oral (enteral) administration. Propranolol oral and intravenous (IV) doses are NOT equivalent and these recommendations do not apply to IV dosing.[2,3] At this time, there are no recommendations to guide parenteral propranolol dosing for infants with hemangiomas.

Cardiovascular parameters and blood glucose should be closely monitored after the initial dose or any dosing change. Manunza and colleagues monitored their patients for changes in heart rate or blood pressure every 30 minutes over a 4-hour period at initiation and whenever the dose was increased.[7] These parameters were also measured twice weekly during the first week and weekly thereafter. Maturo and Hartnick describe as similar protocol, with hourly blood pressure and heart rate checks for 4 hours.[5]


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