Beta-Blocker — Infantile Haemangioma (Airway) Pregnancy: Not applicable (infantile haemangioma — paediatric indication); propranolol used in pregnancy for maternal cardiac/hypertensive indications under specialist guidance

Propranolol

Brand names: Hemangiol, Inderal

Adult dose

Dose: Subglottic haemangioma / head and neck haemangioma: 1–3 mg/kg/day (divided doses) — based on paediatric indication. Adult ENT use: perioperative beta-blockade or autonomic control — per individual protocol

Route: Oral

Frequency: Twice daily (divided doses)

Max: 3 mg/kg/day for infantile haemangioma

Primary ENT indication: propranolol is first-line treatment for infantile haemangioma — particularly subglottic/airway haemangiomas which cause stridor and airway compromise. Hemangiol is the licensed oral solution formulation. Must initiate under cardiac monitoring.

Paediatric dose

Dose: Start 1 mg/kg/day; increase to 2 mg/kg/day after 1 week; max 3 mg/kg/day mg/kg

Route: Oral

Frequency: Twice daily (with or after feeding — hypoglycaemia prevention)

Max: 3 mg/kg/day

BNFc/Hemangiol SPC: initiate in hospital under cardiac monitoring (ECG, BP, blood glucose). Licensed from 5 weeks corrected gestational age for infantile haemangioma. Treatment duration typically 6 months (until 12 months of age).

Dose adjustments

Renal

No dose adjustment required in children for haemangioma indication

Hepatic

Reduce dose in hepatic impairment — hepatic metabolism

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

LEAP trial and NEJM 2008 (Léauté-Labrèze): propranolol is first-line for proliferating infantile haemangioma — largely replaced systemic corticosteroids
Subglottic haemangioma: presents with biphasic stridor and progressive airway compromise typically at 6–12 weeks of age; propranolol can rapidly shrink lesion and avoid tracheostomy
Hypoglycaemia risk: ALWAYS give dose immediately after feeding — never on empty stomach; instruct parents on hypoglycaemia recognition (lethargy, pallor, poor feeding) — beta-blockade masks tachycardia warning sign
Initiation protocol: inpatient monitoring for first dose; HR, BP, and blood glucose monitoring for 2 hours after first dose and after dose increase
Rebound growth: rare but can occur if propranolol stopped abruptly — gradual weaning recommended at end of treatment course
Timolol gel 0.5% (ophthalmic solution applied topically) is an alternative for superficial uncomplicated haemangiomas — used off-label

Contraindications

Asthma or bronchospasm (ABSOLUTE contraindication — beta-2 blockade)
Bradycardia (<80 bpm in infants)
Hypoglycaemia history (especially premature infants)
Cardiogenic shock
Uncontrolled heart failure
Raynaud's phenomenon (severe)

Side effects

Bradycardia
Hypoglycaemia (infants — must feed before each dose)
Bronchospasm
Sleep disturbance
Hypotension
Cold extremities
Hypoglycaemia masked by beta-blockade (tachycardia sign suppressed)

Interactions

Antidiabetics — hypoglycaemia risk and masked symptoms
Calcium channel blockers — additive bradycardia
Anaesthetic agents — myocardial depression

Monitoring

Heart rate (bradycardia)
Blood glucose (particularly in infants)
Blood pressure
Haemangioma size (clinical and photography)
Respiratory status

Reference: BNFc; BNF 90; BNFc; Hemangiol SPC; Léauté-Labrèze et al. NEJM 2008; LEAP Trial; NICE guidance Infantile Haemangioma. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways