Adverse Events in Young and Preterm Infants Receiving Topical Timolol for Infantile Hemangioma

Abstract

In this cohort of at-risk infants, topical timolol appeared to provide safe treatment for IHs in full-term infants receiving a dose of less than 0.2 mg/kg/day, but infants with a PMA of less than 44 weeks and weight at treatment initiation of less than 2,500 g may be at risk of adverse events, including bradycardia, hypotension, apnea, and hypothermia. We recommend close monitoring of temperature, blood pressure, and heart rate in premature and low-birthweight infants with IHs at initiation of and during therapy with topical timolol.

Temperature Instability in an Infant Treated with Propranolol for Infantile Hemangioma

“…One case report exists describing potential hypothermia in patients receiving Temperature Instability and Propranolol topical timolol, an alternative treatment for IH. 6 This report describes the potential side effect and possible mechanisms of temperature instability in a premature infant while on topical timolol and subsequently oral propranolol. Also, it supports the emerging treatment of atenolol for IH.…”

Topical propranolol for infantile haemangiomas: a systematic review

“…28,29 The increased efficacy of oral vs. topical propranolol could be explained by a combination of local and systemic mechanisms of action. 33,34 In vitro analysis of the permeation of beta-blockers through the human epidermal membrane revealed that propranolol was ten times more permeable than timolol. [30][31][32] A meta-analysis identified an 83% response rate in superficial infantile haemangiomas treated with topical timolol.…”

Doing the math: A simple approach to topical timolol dosing for infantile hemangiomas

“…Calculating the safe, appropriate maximum daily dose of topical timolol can be time consuming. Because each drop of the medication measures 0.05 mL, and the concentration of topical timolol GFS is 0.5%, one drop contains 0.25 mg of timolol . Because the recommended daily dosage is less than 0.25 mg/kg, the maximum safe daily dose of timolol can be simplified to 1 drop per kilogram of body weight (Figure ).…”

“…Infantile hemangiomas (IH) are benign capillary tumors that involute spontaneously and often do not require treatment. First‐line treatment with propranolol can be beneficial in high‐risk cases (e.g., possibility of disfigurement or systemic complications) . Because propranolol is administered orally, it carries some risk of systemic side effects.…”

“…Subsequent studies indicate that topical timolol is safe and effective, especially for superficial IH . Because it is applied topically, it is less likely than oral beta‐blockers to cause systemic side effects such as hypotension, bradycardia, hypoglycemia, and bronchospasm, although caution is still advised, especially when applying to mucosal surfaces or ulcerated lesions, in very young and preterm infants, and in occluded areas such as the diaper region …”