From the Guidelines
The starting dose of propranolol for infants is 1 mg kg-1 daily in three divided doses, according to the British Society for Paediatric Dermatology consensus guidelines 1. When initiating propranolol in infants, it is essential to consider the patient's age, comorbidities, and weight.
- For infants older than 4 weeks, with no significant comorbidities, born at term, with normal birthweight, established feeds, and appropriate weight gain, the starting dose is 1 mg kg-1 daily in three divided doses 1.
- For preterm patients and those with comorbidities, the propranolol starting dose may need to be modified, with a typical starting dose of 0.5 mg kg-1 daily 1. Key considerations when starting propranolol in infants include:
- Monitoring heart rate and blood pressure, particularly in patients younger than 4 weeks of age or those with significant comorbidities 1.
- Checking blood glucose levels in patients at risk of hypoglycaemia, such as preterm infants and low-weight neonates with faltering growth, poor feeding, and a history of hypoglycaemia 1.
- Ensuring regular feeding to reduce the risk of hypoglycaemia, and stopping propranolol if feeding is reduced 1.
From the Research
Propranolol Starting Dose for Infants
- The starting dose of propranolol for infants with infantile hemangioma is typically 1-3 mg/kg/day, as reported in studies 2, 3, 4.
- A study published in 2024 found that administration of R(+) propranolol once a day at a dose of 1 × 25 mg/kg/day was sufficient to block vasculogenesis in a xenograft model of infantile hemangioma, with no significant difference observed between this regimen and a twice-daily dose of 2 × 12.5 mg/kg/day 5.
- Another study from 2022 reported that propranolol was safe and effective for the treatment of infantile hemangiomas in infants less than five weeks corrected age, with a dose range of 1-3 mg/kg/day 2.
- A 2015 study found that propranolol at a dose of 1.0 to 1.5 mg/kg/day was effective in treating complicated infantile hemangiomas, with no significant decrease in mean systolic and diastolic blood pressures and mean heart rate 3.
- A 2011 study reported that propranolol at a dose of 2 mg/kg/day was effective in treating proliferating complicated infantile hemangiomas, with significant fading of color and decrease in size of the hemangioma 4.
- A 2025 study found that oral propranolol initiation was safe in pediatric patients, with significant decreases in blood pressure and heart rate, but no symptomatic hypoglycemia or clinically meaningful differences in vital sign alterations between different patient populations 6.