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| hemangioma_treatment [2018/07/30 03:29] – [Dosing] Scott Larson | hemangioma_treatment [2025/04/18 20:40] (current) – external edit 127.0.0.1 | ||
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| ===== Propranolol ===== | ===== Propranolol ===== | ||
| ==== Dosing ==== | ==== Dosing ==== | ||
| - | === USA consensus | + | === Preferred Dosing |
| + | * 1 mg/kg/d divided BID for 1 week | ||
| + | * 1.5 mg/kg/d divided BID for 1 week | ||
| + | * 2 mg/kg/d divided BID keep at this dose | ||
| + | == Common Alternate dosing | ||
| * 1 mg/kg/d divided TID for 1 week | * 1 mg/kg/d divided TID for 1 week | ||
| * 1.5 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 | * 2 mg/kg/d divided TID keep at this dose | ||
| - | === French RCT === | + | == French RCT Dosing |
| * 1 mg/kg/d divided BID for 1 week | * 1 mg/kg/d divided BID for 1 week | ||
| * 2 mg/kg/d divided BID for 1 week | * 2 mg/kg/d divided BID for 1 week | ||
| * 3 mg/kg/d divided BID | * 3 mg/kg/d divided BID | ||
| === Other Considerations === | === Other Considerations === | ||
| - | * Minimum | + | * 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 | ||
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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 | ||
| - | === Outpatient Treatment Initiation | + | === Protocol === |
| - | - Baseline BP and HR | + | [[propranolol_for_hemangioma_protocol|See Outpatient Treatment of hemangioma with Propranolol |
| - | - Propranolol | + | |
| - | - Check BP and HR 1 and 2 hours after first dose | + | |
| - | - IF not tolerated: | + | |
| - | - IF tolerated: Ensure minimum of 6 hours between doses, warning signs, feed regularly and hold dose if PO intake compromised, | + | |
| - | - In 3-7 days: Increase dose to 0.5 mg/kg PO TID (minimum 6 hours between doses) | + | |
| - | - Check BP and HR 1 and 2 hours after new dose | + | |
| - | - If not tolerated: | + | |
| - | - If tolerated: discharge home | + | |
| - | - In 3-7 days Increase dose to 0.66 mg/kg PO TID (q 6h minimum) (2 mg/kg/day) | + | |
| - | - Check BP and HR at 1 and 2 hours after new dose | + | |
| === Treatment Location === | === Treatment Location === | ||
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| =====Other Treatments===== | =====Other Treatments===== | ||
| + | * Surgical Excision | ||
| - | |||
| - | * Surgical Excision | ||
| ===== References ===== | ===== References ===== | ||
| + | * See [[propranolol_for_hemangioma_protocol|Protocol for Outpatient Propranolol for Infantile and Childhood Hemangioma]] | ||
| * A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma 2015 {{: | * A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma 2015 {{: | ||
| * Initiation and Use of Propranolol for Infantile Hemangioma: Report of a Consensus Conference 2013{{http:// | * Initiation and Use of Propranolol for Infantile Hemangioma: Report of a Consensus Conference 2013{{http:// | ||