Propranolol for Hemangioma: Outpatient Protocol -CEW

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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

Other Considerations

Try for 6 hours between doses
Hold if child can't take PO
Child should not skip meals
Typically use for minimum 6 months, 12 months have less recurrences
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

Baseline BP and HR
Propranolol 0.5 mg/kg (1 mg/kg/day) PO BID
Check BP and HR 1 and 2 hours after first dose
IF not tolerated: gradually increase to 0.5 mg/kg PO
IF tolerated: Ensure minimum of 6 hours between doses, warning signs, feed regularly and hold dose if PO intake compromised, Discharge to home
In 3-7 days: Increase dose to 0.75 mg/kg PO BID (1.5 mg/kg/day)
Check BP and HR 1 and 2 hours after new dose
If not tolerated: Keep at 1 mg/kg/day and assess efficacy
If tolerated: discharge home
In 3-7 days Increase dose to 1 mg/kg PO BID (2 mg/kg/day)
Check BP and HR at 1 and 2 hours after new dose

Normal Vital Signs in Infants

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

Hypoglycemia- child should eat every 4 hours
Hypotension- check blood pressure after dose change
Bradycardia- check pulse after dose change
Infant Vital Signs

Parents to call if...

Lethargy
Cool Clammy skin
Breathing Difficulties

drugs