Propranolol Treatment for Hemangiomas

Propranolol is a medicine used to safely lower blood pressure and heart rate in adults and children. Propranolol can shrink a type of birthmark called infantile hemangiomas in some patients.

Not all hemangiomas need to be treated with a medicine like propranolol. Propranolol may be used if your baby has hemangiomas that are:

• Bleeding or have sores (ulcers)
• At risk for bleeding
• Very large
• In the airway and make it hard to breathe
• Affecting how your baby nurses or sucks on a nipple
• On the face or likely to leave a scar if untreated
• Near the eye and affecting vision
• Inside the body, such as on the liver

Your baby may need to take propranolol for 6 months or more. Propranolol works best during the time the hemangioma is growing, usually the first 12 months after your baby is born. One of our providers will meet with you regularly during treatment to ensure the medicine is working.

Near the end of treatment, we will slowly lower the amount of medicine your baby is taking until they completely stop. Then we will watch to see if the hemangioma begins to return. If it returns, we may extend treatment for a few more months.

It is important that your baby see their care provider regularly. We base the amount of propranolol your baby gets on their weight. As your baby grows, they will need a larger amount.

Propranolol is a liquid medicine your baby will take by mouth 2 to 3 times a day or about every 8 hours. For most babies, we give the first dose of propranolol in clinic. We will monitor your baby’s heart rate and blood pressure once an hour for the first 3 hours. This is to be sure that your baby’s heart rate and blood pressure stay within the normal range for their age.

At this appointment, we will teach you:

• How to give your baby the propranolol
• About the possible side effects and what to watch out for

Because propranolol can have effects on heart rate and blood pressure, some babies will need an exam by a heart doctor (cardiologist) before starting treatment. If your child already has a cardiologist, we may be able to ask them for clearance to give this medicine. If you do come in to see the cardiologist, this appointment may include:

• Blood pressure and heart rate check: We will check your baby’s blood pressure using a blood pressure cuff and their heart rate with a stethoscope.
• Electrocardiogram (ECG or EKG): This test records your baby’s heart beats to test the electrical pathways of the heart. We will place small sensors (stickers) on your baby’s skin. Most babies do not have issues with the ECG or EKG.
• Echocardiogram (ECHO): This test uses sound waves to create pictures of the heart. This includes the heart's valves and chambers. To do this, we pass a probe, called a transducer, over your baby’s chest skin. Most babies do not have issues with ECHOs.

This is the most common side effect of propranolol. It is most noticeable when your child first starts the medicine and when their dose is increased. At each appointment, we will check your child’s blood pressure and heart rate.

These are common side effects when your child first starts the medicine. They usually go away after the first week.

Low blood sugar is an uncommon side effect. It is uncommon because babies at this age eat so often. It is more likely to happen if your child is sick, has lost their appetite or has not eaten for a long time because of a procedure. You can prevent this by feeding your child as you usually do. Do not give propranolol if your child has a decreased appetite or has missed meals due to illness or other reasons.

Young children and infants may become irritable, jittery or act hungry (crying) when they have low blood sugar. If you notice this in your sick child, stop the propranolol, give your child Pedialyte, and get medical help right away by calling your pediatrician or the Vascular Anomalies Clinic. If you are unable to wake your child, call 911.

Coughing or wheezing are rare side effects with propranolol. At each appointment, we will ask you if you notice your child doing this. If your child has cough or wheeze with propranolol, we may reduce or stop the propranolol dose.

It is OK to take propranolol with:

• Ibuprofen (Advil or Motrin)
• Acetaminophen (Tylenol)
• Vitamin D
• Antibiotics
• Vaccines

It is not ok to take propranolol with medicines that help breathing like albuterol, a beta2-agonist. If your baby needs albuterol, stop the propranolol while your baby is actively using albuterol. You can restart it when your baby no longer needs albuterol. Call the clinic if your baby needs albuterol.

If you are unsure about a medicine that is not listed, contact us.

To contact the clinic, call 206-987-4606. Choose option 1 to schedule or change appointments or option 4 to speak with a nurse. You can also send a message through MyChart and attach pictures if you have concerns about your child's hemangioma.