Related Experiment Video
Updated: Aug 2, 2025
In Vivo Real-Time Study of Drug Effects on Carotid Blood Flow in the Ovine Fetus
Published on: April 28, 2023
Cardiac side effects of propranolol in infants treated for infantile haemangiomas
Numila Maliqari1, Enkeleda Duka2, Loreta Kuneshka3
1Pediatric Cardiology Department, Mother Theresa University Hospital, Tirana, Albania.
Insights
Propranolol is a safe first-line treatment for infantile haemangiomas, with rare severe cardiac events. This study confirms its safety profile, easing concerns for parents and physicians regarding propranolol treatment.
Area of Science:
- Dermatology
- Pediatrics
- Pharmacology
Background:
- Infantile haemangiomas are common vascular tumors in infants.
- Propranolol is an effective treatment but concerns exist regarding cardiac side effects.
- Parental and physician hesitancy can impede propranolol treatment initiation and adherence.
Purpose of the Study:
- To evaluate the safety profile of propranolol for infantile haemangiomas.
- To specifically assess cardiac adverse events associated with propranolol therapy.
- To provide evidence supporting propranolol as a safe first-line treatment option.
Main Methods:
- Prospective observational and analytic study.
- 476 patients with infantile haemangioma treated with systemic propranolol (January 2011-December 2021).
- Monitored clinical adverse events, blood pressure, and heart rate.
Main Results:
- Symptomatic adverse events were generally mild; severe events were rare.
- Most common side effects: paleness, sweating, reduced feeding, agitation.
- Severe respiratory symptoms (1.8%), hypoglycemia (2.7%), and cardiac symptoms (1.2%) were infrequent. Statistically significant blood pressure reduction occurred at maintenance dose; symptomatic hypotension in only four patients. Symptomatic bradycardia occurred in two patients.
Conclusions:
- Propranolol demonstrates an excellent safety profile for infantile haemangioma treatment.
- Severe cardiac adverse events are very rare and manageable with treatment interruption.
- The study supports propranolol as a safe and effective first-line therapy.
Objectives:
This study aims to add proof to the safety profile of propranolol as first-line choice in treating infantile haemangiomas, in particular related to its cardiac side effects the main hindering reason for parents and physicians to start and comply with treatment.
Method:
This is a prospective observational and analytic study with a sample of 476 patients diagnosed with infantile haemangioma and treated with systemic propranolol during the time interval January 2011 to December 2021. We studied clinical propranolol adverse events experienced in hospital or outpatient and measured the impact of propranolol on blood pressure and heart rate.
Results:
This study showed that symptomatic adverse events caused by propranolol were mild and severe adverse events were rare. The most common clinical side effects were paleness, sweating, reduced feeding, and agitation. Only in 28 (5.9%) cases these symptoms were severe enough to review treatment, 1.8% had severe respiratory symptoms, 2.7% experienced hypoglycaemia, and 1.2% had heart-related symptoms. Mean blood pressure reduction with treatment was statistically significant only after achieving the maintenance dose 2 mg/kg body weight. Blood pressure under the 5th percentile was registered in 2.9% of cases, but only four patients had symptomatic hypotension. While heart rate reduction was noticed with the first dose, only two experienced symptomatic bradycardia.
Conclusion:
We conclude that propranolol is not only an excellent drug in treating infantile haemangioma, but it has also a very safe profile, with mild side effects and very rare severe cardiac adverse events, easily overcome with treatment interruption.
Related Concept Videos
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
01:28Antihypertensive Drugs: Types of β-Blockers
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:16Antianginal Drugs: Nitrates and β-Blockers
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow....
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...