Propranolol for Hemangiomas

Propranolol has been used for many years by cardiologists (heart doctors) to treat heart problems. It is now also used by dermatologists to treat hemangiomas. A hemangioma is a common type of blood-vessel birthmark. (See Helping Hand HH-I-310, Hemangioma.)

Many hemangiomas do not cause problems and often go away with time. Some are very large, have open sores, or can affect certain body parts as they grow (like the eyes, nose or mouth). Propranolol may greatly lighten or shrink the hemangioma. It may help to heal open areas. It may also help stop the growth of hemangiomas that cause other problems.

An electrocardiogram (EKG) is done to check how the heart is working before giving this medicine. (See Helping Hand HH-III-6, EKG (Electrocardiogram).) If your child is 3 months or younger (corrected age if premature) this medicine may be started in the hospital. Your child will be watched closely after taking it. Children older than 3 months are often started on this medicine while in the clinic.

Most patients do well on this medicine and do not have problems. Serious side effects are rare but could occur. See the section Side Effects on pages 2 and 3.

How to Give This Medicine

• Your child’s dose of propranolol is chosen carefully. It is adjusted for your child’s weight and response to treatment.

Always give the exact amount prescribed. Never increase the dose or “round up” the dose.

• Use a pediatric measuring device (Picture 1) to measure the exact dose. These are available at the pharmacy. Do not use kitchen spoons to measure liquid medicines.
• You may have trouble measuring the exact amount. If so, ask the clinic or pharmacy for a calibrated syringe (Picture 1).
• Read the label carefully.
• Stay with your child until he or she has swallowed the dose of medicine.

Give this medicine with food. In order to prevent low blood sugar (hypoglycemia) it is important to give each dose with a meal. Food, formula, or breast milk should be given immediately before or along with the dose of medicine.

Give the propranolol as closely as possible to the prescribed time. Usually it is to be taken either every 8 hours or every 12 hours. The medicine label will tell you how often to give it. To give this medicine at the right times and give the propranolol with food, pick times that work well with your child’s sleeping and feeding schedule. It is okay to give the medicine up to 60 minutes early or 60 minutes later than the usual scheduled dose. This is allowed occasionally to fit your child’s schedule.

It is helpful to give one or two adults in the household the role of giving this medicine. For safety, only people who normally care for your child should give propranolol.

If You Forget to Give a Dose

If you forget to give the medicine and it has been more than 60 minutes since the scheduled time, do not give the missed dose. Skip it and continue with the regular schedule starting at the next dosing time. Do not double a dose to make up for a missed dose.

If a Dose is Vomited

If your child spits up or vomits a dose of propranolol, skip that dose.

Never re-dose. Never double up on doses. Start the regular dose again at the next scheduled time.

Possible Side Effects

Because of the risk for side effects, children less than 3 months old are often started on this medicine in the hospital. If this is necessary, your child’s doctor will discuss it with you further.

Low blood sugar (hypoglycemia). Your child will not be able to tell you if he or she is experiencing low blood sugar.

Common signs of low blood sugar may include:

• irritability
• restlessness
• lethargy (extreme tiredness or inactivity)

A child with severe low blood sugar could have seizures or not be able to be awakened. If this happens, call for emergency help.

Slower heart rate (bradycardia) and lower blood pressure. The dose of propranolol that is prescribed for treating hemangiomas is low, and usually does not cause serious bradycardia or low blood pressure. The child’s heart rate and blood pressure are checked at every visit to make sure this is not happening.

Worsening of bronchospasm, asthma or wheezing. Propranolol should not be given to children with a known history of asthma. Propranolol may increase the likelihood of wheezing. If your child were to start wheezing while on propranolol, the medicine would need to be stopped.

Other Medicines. Propranolol may not work well with other medicines. Check with your child’s doctor and pharmacist before adding any new medicines.

What to Do About Side Effects

Call your child’s doctor if any side effects continue or are very bothersome.

If your child develops wheezing while on this medicine, it should be stopped until the wheezing stops. Once your child is healthy, you may restart the propranolol.

When NOT to Give This Medicine

There are certain times when propranolol should not be given. At these times, it is okay to skip a dose or stop the propranolol completely until the reason is resolved:

Do not give propranolol if your child is:

• fasting (not eating) before surgery or for any other reason
• unable to eat or eating much less than usual
• vomiting
• lethargic (unusually tired or inactive) or has poor energy
• cool clammy to the touch
• wheezing or having trouble breathing

Medicine Storage

• Do not keep this medicine in the refrigerator. Store at room temperature.
• Always keep medicine in the original bottle from the pharmacy.
• Store all medicine out of the reach of children.

When to Call for Emergency Help

Call for emergency help if your child has any of these signs. It could be an allergic reaction if your child:

• has trouble breathing
• is not responsive
• has seizure-like activity after taking this medicine.

Propranolol for Hemangiomas (PDF)

HH- V-267 2/16 Copyright 2016, Nationwide Children's Hospital