Initiation of Propranolol
Consensus guidelines for initiation and monitoring of propranolol have recently been published. For infants younger than 2 months of age, brief inpatient hospitalization for monitoring during induction of treatment is generally recommended. For infants over 2 months of age, propranolol can be initiated in an outpatient setting unless there are medical co-morbidities or inadequate social support. After a careful history and physical examination to exclude any reactive airway or cardiac disease, baseline heart rate and blood pressure are obtained. Initial dosing of propranolol starts at 0.5 mg/kg/day divided three times daily, increasing slowly to a maximum of 2 mg/kg/day. Heart rate and blood pressure are monitored before and throughout the course of dose escalation, as well as at 1 and 2 hours following the initial dose. Parents should be informed of the risks of hypoglycemia and advised to feed infants every 4–6 hours.
Skin Therapy Letter. 2013;18(6) © 2013 SkinCareGuide.com