From the Guidelines
Oral propranolol is indicated for the treatment of infantile hemangiomas in newly born infants, particularly those with ulceration, risk of disfigurement, or functional impairment, as stated in the British Society for Paediatric Dermatology consensus guidelines 1. The recommended starting dose is 0.5-1 mg/kg/day divided into three equal doses, gradually increasing to a target maintenance dose of 2-3 mg/kg/day divided into three doses, as suggested by the clinical practice guideline for the management of infantile hemangiomas 1. Key considerations for treatment include:
- Early intervention, ideally by 1 month of age, for infants with potentially problematic IHs 1
- Cardiac evaluation, including ECG and echocardiogram, to rule out contraindications before initiating treatment 1
- Blood glucose monitoring, especially during initiation, as propranolol can cause hypoglycemia in infants 1
- Education of parents about potential side effects, including hypoglycemia, bradycardia, hypotension, bronchospasm, and sleep disturbances, and instruction to administer the medication with feeds to minimize hypoglycemia risk 1 The duration of therapy generally ranges from 6-12 months, with gradual tapering when discontinuing to prevent rebound growth, as recommended by the clinical practice guideline for the management of infantile hemangiomas 1. Propranolol works by causing vasoconstriction through beta-adrenergic blockade, decreasing expression of vascular endothelial growth factors, and triggering apoptosis of capillary endothelial cells, which collectively leads to regression of the hemangioma, as explained in the British Society for Paediatric Dermatology consensus guidelines 1.
From the Research
Indication for Oral Propranolol in Congenital Vascular Malformation
The indication for oral propranolol in congenital vascular malformation, specifically for newly born infants, is primarily focused on the treatment of infantile hemangiomas.
- Infantile hemangiomas are a type of congenital vascular malformation that can appear as benign tumors on the skin, often presenting at birth or shortly after.
- The use of oral propranolol for infantile hemangiomas has been studied extensively, with evidence showing its efficacy in reducing the size and color of these lesions 2, 3, 4.
- Propranolol, a non-selective β-blocker, has become a first-line treatment for problematic infantile hemangiomas that are not amenable to topical or intralesional therapies 5.
Efficacy and Safety
Studies have demonstrated that oral propranolol is effective in treating infantile hemangiomas, with significant reductions in volume, color, and elevation observed in treated patients 2, 3.
- The safety profile of propranolol in infants has been evaluated, with common side effects including sleep disturbances, and less frequently, reversible bronchospasm and other minor adverse events 4, 6.
- The efficacy of propranolol for vascular anomalies other than infantile hemangiomas is less clear, with some studies suggesting that it may not be effective for these conditions 5.
Treatment Guidelines
For newly born infants with infantile hemangiomas, oral propranolol may be considered as a treatment option, particularly for lesions that are at risk of causing disfigurement or other complications.
- The typical dosage of propranolol for infantile hemangiomas is 1-2 mg/kg/day, divided into 2-3 doses, with treatment duration varying depending on the response to therapy 2, 3, 6.
- Close monitoring of the infant's heart rate, blood pressure, and blood glucose levels is recommended during treatment with propranolol, especially in the initial stages 3.