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Severe hypoglycemia in propranolol treatment for infantile hemangiomas
Akira Morimoto1,2, Michio Ozeki3, Satoru Sasaki4
1Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan.
Insights
Propranolol (PPL) treatment for infantile hemangioma can cause severe hypoglycemia, especially in infants over one year old. Careful administration timing and monitoring are crucial to prevent this serious side effect.
Area of Science:
- Pediatric Pharmacology
- Dermatology
- Endocrinology
Background:
- Infantile hemangioma (IH) is a common benign vascular tumor in infants.
- While propranolol (PPL) is a first-line treatment for IH, its potential for severe hypoglycemia is not widely recognized.
- IH sequelae can occur in up to 50% of untreated patients.
Purpose of the Study:
- To investigate the incidence and characteristics of severe propranolol-induced hypoglycemia in infants with infantile hemangioma.
- To identify risk factors and provide recommendations for safe PPL administration.
Main Methods:
- Retrospective analysis of patients treated with PPL for IH in Japan.
- Study period: 3 years following the launch of a PPL preparation specific for IH.
- Data collection focused on severe hypoglycemia and hypoglycemic convulsions.
Main Results:
- The incidence of severe hypoglycemia was 0.54% and hypoglycemic convulsions was 0.35%.
- Hypoglycemic convulsions incidence was higher in Japan compared to Western countries.
- Risk factors included age over 1 year, treatment duration ≥6 months, morning administration (5-9 AM), prolonged fasting, and poor infant condition.
Conclusions:
- Initiate PPL treatment by 6 months of age during the proliferative phase and avoid extending treatment indiscriminately beyond 1 year.
- Advise guardians against administering PPL on an empty stomach or when the infant is unwell.
- Emphasize monitoring the infant closely after waking and avoiding prolonged fasting post-administration.
Background:
Infantile hemangioma (IH), formerly termed strawberry hemangioma, is a benign vascular tumor caused by capillary endothelial cell proliferation. The tumor regresses after 1 year of age, but sequelae occur in approximately half of the patients without systemic treatment. Propranolol (PPL) is currently the first-line therapeutic agent in Japan as well as in Western countries. It is not commonly known that PPL may induce severe hypoglycemia, in addition to cardiovascular and respiratory side effects.
Methods:
We retrospectively analyzed patients with severe PPL-induced hypoglycemia in the 3 years since the launch of Hemangiol®, a PPL preparation specific for IH, in Japan in 2016.
Results:
The incidence of severe hypoglycemia and of hypoglycemic convulsions following PPL treatment was estimated to be 0.54% and 0.35%, respectively. The incidence of hypoglycemic convulsions appeared to be higher in Japan than in Western countries. Severe hypoglycemia was common in infants aged >1 year, when PPL was used for ≥6 months. Severe hypoglycemia often develops from 05:00 a.m. to 09:00 a.m. and is frequently associated with prolonged periods of fasting, poor feeding, or poor physical conditions.
Conclusion:
To avoid the risk of hypoglycemia, the treatment should be initiated by 6 months of age during the proliferative phase at the latest, and should not be extended indiscriminately beyond 1 year of age. Guardians should be advised not to administer PPL on an empty stomach, in the presence of poor feeding, or who are in poor physical condition, not to prolong fasting after PPL administration, and to monitor the child's condition immediately after he or she wakes up.
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