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hemangioma_treatment [2018/07/30 03:04] Scott Larsonhemangioma_treatment [2025/04/18 20:40] (current) – external edit 127.0.0.1
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 ===== Propranolol ===== ===== Propranolol =====
 ==== Dosing ==== ==== Dosing ====
- +=== Preferred Dosing === 
-  * 1 mg/kg/d divided TID or BID for 1 week +  * 1 mg/kg/d divided BID for 1 week 
-  * 2 mg/kg/d divided TID or BID for 1 week +  * 1.5 mg/kg/d divided BID for 1 week 
-  * mg/kg/d divided TID or BID- keep at this dose (can increase with change in weight) +  * 2 mg/kg/d divided BID keep at this dose 
-  * Minimum 6 hours between doses+== Common Alternate dosing == 
 +  * 1 mg/kg/d divided TID for 1 week 
 +  * 1.5 mg/kg/d divided TID for 1 week 
 +  * 2 mg/kg/d divided TID keep at this dose 
 +== French RCT Dosing == 
 +  * 1 mg/kg/d divided BID for 1 week 
 +  * 2 mg/kg/d divided BID for 1 week 
 +  * 3 mg/kg/d divided BID 
 +=== Other Considerations === 
 +  * Try for 6 hours between doses
   * Hold if child can't take PO   * Hold if child can't take PO
   * Child should not skip meals   * Child should not skip meals
-  * Typically use for minimum 6 months+  * Typically use for minimum 6 months, 12 months have less recurrences
   * When lesion treated, tapering is common to ensure no recurrence of the lesion   * When lesion treated, tapering is common to ensure no recurrence of the lesion
-  * Monitor Blood pressure and pulse 1 and 2 hours after any dose increase of >0.5 mg/kg/day+  * Monitor Blood pressure and pulse 1 and 2 hours after any dose increase of >0.5 mg/kg/day
 ==== Pre-Treatment issues ==== ==== Pre-Treatment issues ====
  
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     * if PHACE is suspected: MRI/ MRA of head and neck and Echocardiogram      * if PHACE is suspected: MRI/ MRA of head and neck and Echocardiogram 
     * Slow titration up, lowest effective dosing, inpatient observation and TID dosing      * Slow titration up, lowest effective dosing, inpatient observation and TID dosing 
 +=== Protocol ===
 +[[propranolol_for_hemangioma_protocol|See Outpatient Treatment of hemangioma with Propranolol Protocol]]
 +
 +=== Treatment Location ===
 +  * Inpatient for <8 weeks old or any age with inadequate social support or co-morbid conditions affecting the cardiovascular or respiratory system
 +  * Outpatient for > 8 weeks old with good social support and no co-morbid conditions
 +
  
 ==== Adverse Effects ==== ==== Adverse Effects ====
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 =====Other Treatments===== =====Other Treatments=====
 +  * Surgical Excision
  
- 
-  * Surgical Excision 
 ===== References ===== ===== References =====
-  * A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma {{:oral_propranolol_in_infantile_hemangioma_randomized_controlled_trial_nejm.pdf|PDF}} +  * See [[propranolol_for_hemangioma_protocol|Protocol for Outpatient Propranolol for Infantile and Childhood Hemangioma]]  
-  * Initiation and Use of Propranolol for Infantile Hemangioma: Report of a Consensus Conference {{http://pediatrics.aappublications.org/content/131/1/128?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token|Journal of Pediatrics}}+  * A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma 2015 {{:oral_propranolol_in_infantile_hemangioma_randomized_controlled_trial_nejm.pdf|PDF}} 
 +  * Initiation and Use of Propranolol for Infantile Hemangioma: Report of a Consensus Conference 2013{{http://pediatrics.aappublications.org/content/131/1/128?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token|Journal of Pediatrics}}
  
  
 {{tag>drugs}} {{tag>drugs}}