Propranolol (Infantile Haemangioma / Paediatric Arrhythmias)

How it works

Beta-adrenoceptor blockade reduces heart rate and conduction; in haemangioma it is thought to cause vasoconstriction, suppress proangiogenic signalling and trigger regression of the lesion.

Prescribing in practice

• It can cause hypoglycaemia, bradycardia, hypotension and bronchospasm in infants, so doses should be given with feeds, treatment paused during intercurrent illness or poor feeding, and it must be avoided in asthma and reactive airways disease.
• Cardiovascular assessment is advised before starting, particularly to exclude significant cardiac or airway disease.
• Doses are weight-based and titrated as the infant grows; check against a children's formulary.

Monitoring

Monitor heart rate, blood pressure and for signs of hypoglycaemia or bronchospasm around initiation and dose increases, and review the haemangioma response periodically.

Counselling the patient

• Always give with or straight after a feed and never to a fasting baby.
• Stop and seek advice if the baby is unwell, not feeding, vomiting or wheezy.
• Watch for and report pallor, sweating, floppiness or unusual sleepiness, which may indicate low blood sugar.

Evidence & guidelines

Oral propranolol is established as first-line systemic therapy for problematic proliferating infantile haemangioma, supported by randomised trial evidence.