Propranolol for Hemangiomas

Propranolol is often used to treat heart problems and high blood pressure. It can also be used to treat blood vessel birthmarks called hemangiomas. While many hemangiomas are harmless, some are very large, have open sores, or can affect certain body parts as they grow, like the eyes, nose, or mouth.

Propranolol can shrink or stop the hemangioma from growing. It may also help heal open areas.

Starting Propranolol in the Hospital

If your child is 3 months old or younger (corrected age if premature), this medicine will be started in the hospital. This is done because it can cause low blood sugar, a low heart rate, or low blood pressure.

• Your baby will be watched closely for 48 to 72 hours.
• Your baby’s blood sugar and blood pressure will be checked while on the medicine.
• The doctor or health care provider will do a full check (assessment) of your child and ask questions to make sure the medicine is safe.
• Your baby will have an electrocardiogram (EKG) done to make sure their heart is working well before starting this medicine.

Depending on your child and the type of hemangioma, they may need:

• Cardiology (heart) team assessment
• An MRI/MRA of the brain and neck
• Ophthalmology (eye doctor) assessment

How to Give This Medicine at Home

• Your child’s dose of propranolol will be changed based on their weight and how they respond to treatment.
• Always give the exact dose prescribed. Never increase or decrease the dose.
• Read the label carefully. Make sure you’re giving your child the right dose. It’s easy to confuse the many different dosage forms and strengths.
• Use a pediatric measuring syringe to measure the exact dose (Picture 1). These are available at the pharmacy. Do not use kitchen spoons to measure liquid medicines.
• Stay with your child until they have swallowed all the medicine.
• Give this medicine with food to prevent low blood sugar. You can give food, formula, or human milk before or along with the dose.
• You will give your child propranolol every 8 hours or every 12 hours. Pick times to give the medicine that work well with your child’s sleeping and feeding schedules. Try to give it at the same times every day. You can give the medicine 1 hour before or after the scheduled dose.
• For safety, only people who normally care for your child on a regular basis should give propranolol.

Drug Interactions

• If your child is taking any other medicine or herbal supplements, tell the doctor, health care provider, and pharmacist. Some medicines should not be taken with propranolol.
• If you have other questions about propranolol and other medicines your child takes, talk to their doctor, nurse, or pharmacist.

Possible Side Effects

Most patients do well on this medicine and do not have problems. Serious side effects are rare but could occur. Call your child’s doctor or health care provider if any side effects continue or are very bothersome. Some side effects include:

• Low blood sugar. Your child will not be able to tell you if they have low blood sugar. Common signs of low blood sugar may include: irritability, restlessness, and very tired or inactive.
• Severe low blood sugar causing seizures and not being able to be woken up. * If this happens, call 911.
• Slower heart rate and lower blood pressure.
• Worsening of asthma or wheezing. Propranolol should not be given to children with a history of asthma. It may increase the chance of wheezing. The medicine may need to be stopped.

When to Call the Doctor

There are certain times when propranolol should not be given. At these times, it’s okay to skip a dose or stop the propranolol until the reason is fixed. Please call your doctor or health care provider if you have any questions about when to stop or restart propranolol.

DO NOT give propranolol if your child is:

• Not eating (fasting) before surgery or for any other reason.
• Not able to eat or is eating much less than usual.
• Throwing up (vomiting).
• More tired than normal, inactive, or has little energy.
• Has skin that feels cool to the touch.
• Wheezing or having trouble breathing.

When to Call 911

Call 911 for emergency help if your child:

• Has any of these signs of an allergic reaction:
  • Trouble breathing, wheezing, or tightness in the chest
  • Swelling of the tongue, mouth, or throat
  • Itching, hives, or swelling of the hands, feet, or ankles
• Will not wake up or respond.
• Is shaking or having seizure-like activity.

Medicine Storage

Do not keep this medicine in the refrigerator. Store it at room temperature.

Propranolol for Hemangiomas (PDF)

HH-V-267 2/16 Revised 5/2023 | © 2016, Nationwide Children's Hospital