High propranolol initiation dose well tolerated in infantile hemangioma
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Key takeaways:
- There was no significant difference in the rate of adverse events among those initially dosed with daily 1 mg/kg vs. 2 mg/kg (34.1% vs. 23.1%).
- This remained unchanged across weight and age categories.
Initiating infantile hemangioma treatment with propranolol 2 mg/kg per day did not yield more adverse events than 1 mg/kg per day, according to a study.
“Infantile hemangiomas are common vascular tumors in infants and children that pose the risk of serious complications such as ulceration, anatomic distortion and obstruction of vision and airway,” Charles Y. Huang, BS, medical student at Sidney Kimmel Medical College, Thomas Jefferson University, and colleagues wrote. “Oral beta-blocker formulations, primarily propranolol, are widely utilized for the treatment of infantile hemangiomas due to their efficacy and availability. ... However, oral administration of propranolol carries the risk of systemic side effects, including hypoglycemia, hypotension, bradycardia, bronchospasm and cardiovascular or respiratory compromise.”
According to the authors, the current prescribing guidelines recommend initiating propranolol doses at 1 mg/kg per day with up-titration to 2 mg/kg per day for the treatment of infantile hemangiomas. In this retrospective study, the researchers set out to explore the difference in adverse event rates when patients were initiated with 2 mg/kg per day instead of 1 mg/kg.
The study included 244 patients initiated at 1 mg/kg per day (n = 123) or 2 mg/kg per day (n = 121). After examining the data, the researchers found that there was no significant difference in the incidence of adverse events between the groups, with 34.1% and 23.1% of patients in the 1 mg/kg and 2 mg/kg groups, respectively, experiencing adverse events (P < .057).
Among patients that initiated treatment at 2 mg/kg per day, there was no significant difference in the rate of adverse events based on weight or age for those in the first or second quartile for weight or aged younger than 2 months.
Across dosages, 55 patients did demonstrate decreases in systolic blood pressure greater than 20 mmHg and these same patients reported a higher incidence of overall adverse events (P < .035), which Huang and colleagues said “suggests that hemodynamic changes in response to propranolol initiation, rather than dose at initiation” may better indicate adverse events.
“As additional evidence accumulates in the literature, revisions to the current standardized protocol may be considered to enhance efficiency, workflow and cost-effectiveness of providing treatment for infantile hemangiomas,” the authors wrote.
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