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Propranolol guidelines for families

This is one of many handouts for propranolol. If you are a family whose providers has given you different information, please check with him or her.

Propranolol: Guidelines for Families

Propranolol is a commercially available drug which has been used to treat infantile hemangiomas and some other vascular anomalies since 2008. It has been used in children to treat other problems such as abnormal heart rhythms for many many years. It is a relatively safe medication, but as for all medications there are some things you need to know:

  1. Dosing is based on weight. Your child’s current recommended dose is _______________
  2. Propranolol typically is given twice or three times a day. Speak with your doctor if you have a strong preference for one schedule (for example, based on your work schedule).
  3. Sometimes, propranolol is started with a child admitted for several days to the hospital. A variety of blood and heart tests sometimes is ordered as a “baseline.” For most otherwise healthy children older than 2 months of age, propranolol can be started as an outpatient.
  4. Your child’s dose of propranolol may need to be increased as he/she grows. How long to keep your child on this medicine will depend on a number of factors including how well the hemangioma responds, what the expected natural history of the hemangioma will be (at some point, hemangiomas often stop growing on their own, and propranolol can be discontinued).
  5. Your child should probably not be given propranolol if he/she has one of the following problems: asthma, unusually slow heart rate, allergy to propranolol.
  6. Propranolol can cause low blood sugar and should be taken around times of feeding. If your child develops an illness and cannot feed well, discontinue the propranolol. Call your doctor.
  7. Side effects from propranolol are uncommon and are only partly dose-dependent. Problems to look for include:
    1. Change in alertness, decreased ability to wake your child up, poor feeding, seizures: stop propranolol, if your child is alert enough to feed give him/her formula or other sugar containing drink, take your child to ER;
    2. Blue discoloration of legs or arms, cool legs or arms;
    3. Breathing difficulty with wheezing;
    4. Sleep disturbances such as nightmares;
    5. Diarrhea
    6. Reflux
    7. Some side effects may be “subclinical” and will not be apparent except with a physical examination or blood tests (for example, high potassium levels in the blood or mild decreases in heart rate or blood pressure). So, continue to keep follow-up appointments with your doctor.
    8. Before your child begins propranolol or other medications, be sure your doctor or pharmacy has checked to see that there are not “drug interactions” which may require changes in prescriptions.
    9. Insurance usually covers propranolol prescribed for hemangiomas. Ask your doctor to help if yours does not! There is a brand of propranolol, Hemangeol, which may be useful if your baby has reflux or doesn’t like the taste of the generic brand.