Propranolol Treatment of Infantile Hemangiomas: Anticipatory Guidance for Parents and Caretakers

Abstract

Infantile hemangiomas (IH) are benign tumors of endothelial-like cells. Occurring in 4.5% of children, they are the most common tumor of childhood. The great majority of patients with IH will not need treatment, but 10% require systemic treatment. Many treatments have been described for the treatment of IH, but the Food and Drug Administration has not approved any. Over the last decade, numerous reports of successful treatment of IH with propranolol have been published. Despite its widespread use, little is known regarding the proper dosing, safety monitoring, and during of treatment or long-term outcomes for propranolol treatment of IH. Given its potential side effects, detailed education regarding proper administration of the medication as well as warning signs to watch for is necessary for parents and caretakers. Herein, we provide a parental handout that practitioners can individually tailor for use in their clinics when educating parents and caretakers about the use of propranolol for IH. Updates will also need to be made as more is learned regarding the optimal dosing and safety monitoring when using propranolol for this indication. Forward This article is a little different from the usual Techniques for Tots which have typically focused on examination or surgical techniques. We hope the readers will find it useful as an educational tool for families whose children are receiving propranolol for infantile hemangiomas. Ilona J. Frieden M.D. Lawrence F. Eichenfield M.D. Editors, Pediatric Dermatology

Perioküler Bölge Hemanjiyomlarının Tedavisinde Güncel Yaklaşımlar

“…Özellikle tedavinin ilk aşamasında hospitalize edilmeyen olgularda bronkospazm, hipoglisemi, hipotansiyon, bradikardi, uykuya meğil gibi olası yan etkiler açısından uyanık olunması gerektiği konusunda aile uyarılmalıdır. 22 En sık görülen yan etki olarak bronkospazm bildirilmiştir. 18,19,21 Bu yan etkiler dışında gastroözofajial reflü, diyare, konstipasyon, soğuk ekstremiteler, epilepsi nöbetleri de görülebildiği rapor edilmiştir.…”

Propranolol Use for Infantile Hemangiomas

“…According to Arneja et al (2010) , "these complications are generally rare in the pediatric population and found with doses higher than 2 mg/kg per day" (p. 893). Another side effect noted by Martin et al (2013) is a change in sleep pattern including an increase/decrease in sleep and nightmares. Unfortunately, because of the limited literature and research available on the use of propranolol in hemangiomas, a precise protocol for its clinical use does not exist ( Buckmiller et al 2010 ).…”

“…Primary treatment options that have been available in the past for complicated hemangiomas include systemic or intralesional corticosteroids, chemotherapeutic agents, laser treatment, surgery, or a combination of therapies, all of which can include associated side effects ( Buckmiller et al, 2010 ). Currently, there is no medication that is approved by the Food and Drug Administration for the treatment of infantile hemangiomas ( Martin et al, 2013 ). In 2008, a baby was treated for cardiomyopathy with propranolol who incidentally also had an infantile hemangioma.…”

“…leading to visual loss ( Martin et al, 2013 ). Problematic infantile hemangiomas may require intervention during the rapidly proliferative or proliferative phase ( Martin et al, 2013 ).…”

“…Problematic infantile hemangiomas may require intervention during the rapidly proliferative or proliferative phase ( Martin et al, 2013 ). Primary treatment options that have been available in the past for complicated hemangiomas include systemic or intralesional corticosteroids, chemotherapeutic agents, laser treatment, surgery, or a combination of therapies, all of which can include associated side effects ( Buckmiller et al, 2010 ).…”