Treatment of Infantile Hemangiomas With Beta-Blockers

A Review

Sonal Shah, MD; Ilona J. Frieden, MD


Skin Therapy Letter. 2013;18(6) 

In This Article

Side Effects

Propranolol has long been used in the pediatric population for a variety of different conditions including in neonates and infants for supraventricular tachycardia, neonatal hyperthyroidism, and arrhythmias. Doses used have range from as low as 1 mg/kg/day to doses as high as 8 mg/kg/day. This experience combined with that for treating IH have demonstrated a good safety profile and the majority of patients tolerated the doses used to treat IH (1–3 mg/kg/day) with minimal adverse events (AEs). In a recent systematic review, there were 371 total AEs reported in 1189 patients.[26] Though this review did not allow for precise percentages, as some studies failed to report them, it was possible to determine the frequency of AEs among the studies that did so. The most common AEs included sleep disturbance (136 patients), acrocyanosis (61 patients), hypotension (39 patients, although only 5 were deemed "symptomatic"), bradycardia (8 patients, 1 of which was symptomatic), and respiratory events including infections, wheezing, and stridor (35 patients). The most concerning side effect of propranolol is symptomatic hypoglycemia, which was noted in 4 patients, one of whom developed hypoglycemic seizures.[33] Blockade of β-receptors can lead to hypoglycemia due to decreased glycogenolysis, gluconeogenesis, and lipolysis. Although a rare but potentially serious side effect, patients on propranolol may be at risk for hypoglycemia during prolonged periods of fasting or poor oral intake (e.g., during an acute illness), which can occur at any point during therapy. Frequent feedings, as well as administration of the medication following feeds, and avoidance of long periods of sleep can help to minimize this risk.