Propranolol for Hemangioma: Outpatient Protocol

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

Blood Pressure & Pulse screening: Normal Infant Vital Signs
Inappropriate Bradycardia
- Newborns (<1 month old) <70 BPM
- Infants (1-12 months old) <80 BPM
- Children (>12 months old) <70 PBM
Inappropriate Systolic Blood Pressure (< 5th percentile for oscillometric or <2 SD below mean for auscultation)
- Newborn: <57 mm Hg (oscillometric) or 64 mm Hg (auscultation)
- 6 months: < 85 mm Hg (oscillometric) or 65 mm Hg (auscultation)
- 1 year: <88 mm Hg (oscillometric) or 66 mm Hg (auscultation)

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