Propranolol
Propranolol is a medication known as a non-selective beta adrenergic blocker. The drug is used in children with heart (cardiac) problems such as an abnormal heart rate or rhythm. Propranolol has been proven to be safe in this population of patients. There have been some reports of patients who become ill and have symptoms of low blood sugar (hypoglycemia), low body temperature (hypothermia) and low heart rate (bradycardia) while on this medication. These are known side effects of this medication. Most of these reports are rare but still can cause significant issues.
In 2007, two reports appeared in the medical literature describing the incidental finding that infants with hemangioma, given propranolol showed significant decrease in the size of hemangioma. The effect was proposed to be secondary to the factors that effect blood vessel growth or “angiogenesis”. In both studies, the number of patients evaluated was small and most children were older at the start of therapy. Careful monitoring of side effects was not specifically outlined but initial improvement in the size and color of the hemangiomas was noted.
Many physicians have read these reports and are starting to use propranolol in patients with hemangiomas. There have been unpublished reports of patients needing to be hospitalized for episodes of non-symptomatic (no preceding illness) hypoglycemia, hypothermia and bradycardia. Because these studies are small, the information is limited on the side effects and effectiveness of this drug in patients with hemangiomas. In some situations, such as patients with PHACE syndrome this drug may be dangerous and cause more complications.
It is very important that this new medication be studied in a controlled manner. There is presently a large study being proposed that will open at various centers in about 6 months.
If a child is put on propranolol it is important that they are followed in a vascular anomalies center or by a physician with experience taking care of these patients. A plan of care that specifically outlines the evaluations needed prior to the medication and during the medication administration to follow toxicity should be outlined. Most importantly, a documented consent process is advisable.
References:
Leaute-Labreze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo J-B, Taieb A. Letter to the Editor: Propranolol for Severe Hemangiomas of Infancy. N Engl J Med. 358;24;2649-2651.
Beta Adrenergic Blocking Agents in: Oxford Textbook of Clinical Pharmacology 1st Edition, eds. Graham-Smith DG and Aronson JK. Pg 64.
Drugs that Inhibit Adrenergic Nerves and Block Adrenergic Receptors in: Goodman and Gillman: Pharmacological Basis of Therapy, 6th Edition. Pg 192-4.
Chavez H, Ozolins D, Losek J. Hypoglycemia and Propranolol in Pediatric Behavioral Disorders. Pediatrics. 1999;103;1290-1291.
McBride JT, McBride MC, Viles PH. Hypoglycemia Associated with Propranolol. Pediatrics 1973;51;1085-1087
Artman M, Grayson M, Boerth RC. Propranolol in Children: Safety – Toxicity. Pediatrics 1982;70;30-31.
Kallen RJ, Mohler JH, Lin HL. Hypoglycemia. Clinical Pediatrics;19;8;567-568.
NOVA PROVIDES THIS INFORMATION TO FAMILIES AS A RESOURCE. IT IS NOT INTENDED TO ENGAGE IN THE PRACTICE OF MEDICINE OR TO REPLACE THE PHYSICIAN. NOVA DOES NOT CLAIM TO HAVE MEDICAL KNOWLEDGE. NOVA DOES NOT ENDORSE ANY PARTICULAR PHYSICIAN, TREATING FACILITY OR TREATMENT PROTOCAL. IN ALL CASES NOVA AND ITS BOARD OF DIRECTORS RECOMMENDS THAT YOU SEEK THE OPINION OF A PHYSICIAN EXPERIENCED IN THE MANAGEMENT OF HEMANGIOMAS AND VASCULAR MALFORMATIONS.
Revised 2/24/2010
