Hypoglycemia in Children Taking Propranolol for the Treatment of Infantile Hemangioma

Department of Dermatology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA.
Archives of dermatology (Impact Factor: 4.79). 07/2010; 146(7):775-8. DOI: 10.1001/archdermatol.2010.158
Source: PubMed


Propranolol hydrochloride has been prescribed for decades in the pediatric population for a variety of disorders, but its effectiveness in the treatment of infantile hemangiomas (IHs) was only recently discovered. Since then, the use of propranolol for IHs has exploded because it is viewed as a safer alternative to traditional therapy.
We report the cases of 3 patients who developed symptomatic hypoglycemia during treatment with propranolol for their IHs and review the literature to identify other reports of propranolol-associated hypoglycemia in children to highlight this rare adverse effect.
Although propranolol has a long history of safe and effective use in infants and children, understanding and recognition of deleterious adverse effects is critical for physicians and caregivers. This is especially important when new medical indications evolve as physicians who may not be as familiar with propranolol and its adverse effects begin to recommend it as therapy.

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    • "Side effects that needed intervention and/or close monitoring were not dose dependent and included hypotension (rarely symptomatic), bronchial hyperreactivity, and symptomatic hypoglycemia [15]. Regarding hypoglycemia, Holland et al. described 3 patients with IHs who developed symptomatic hypoglycemia during propranolol therapy [16]. Despite that, propranolol's safety record in infants and children is long-standing and excellent, although questions remain about optimal dosing, time, and way of treatment interruption. "
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    ABSTRACT: Propranolol has emerged as a new treatment option for infantile hemangiomas. We describe a 20-month-old boy with a large right parotid hemangioma diagnosed at the age of 37 days. Starting at the age of 2.5 months, he received oral propranolol for 6.5 months. Although the mass regressed, it recurred when propranolol was discontinued. He was successfully retreated at the age of 11 months with propranolol for another 5.5 months without further recurrences. Treatment was tolerated well. Our paper and a review of the literature demonstrate that propranolol appears to be safe and effective for symptomatic infantile parotid gland hemangiomas.
    Full-text · Article · Nov 2012
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    • "(D) Patient #9, age 11 months, worsened subglottic narrowing despite oral steroids and propranolol. of propranolol, although rare, include bradycardia, hypoglycemia, hypotension, bronchospasm (in those with underlying respiratory spastic illnesses), and hyperkalemia. While universal guidelines have yet to be established, some advocate that the medication be increased gradually and the patient observed closely upon initiation of treatment [17] [18]. Steroids have been found to work quickly to relieve symptoms when patients present with respiratory distress. "
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    ABSTRACT: Infantile subglottic hemangiomas are rare causes of airway obstruction. They begin to proliferate at 1-2 months of age and can cause biphasic stridor with or without respiratory distress. Diagnosis requires direct visualization by direct laryngoscopy and bronchoscopy. Various therapeutic options have been utilized for treatment, including tracheotomy, open surgical excision, laser ablation, intralesional steroid injection, systemic steroids, and now oral propranolol. We present a retrospective chart review of infantile subglottic hemangiomas over a 5-year span (January 2005-2010) at a tertiary care pediatric hospital. IRB approval was obtained, and charts were reviewed to find patients with subglottic hemangiomas, including patient characteristics, presentation, workup, medical and surgical management, and outcomes. A case presentation demonstrates diagnostic, management, and treatment strategies and dilemmas encountered. Nine patients were found to have infantile subglottic hemangiomas. Six of nine patients were treated with laser excision, with five of the six having localized subglottic hemangiomas. In 2009, three of four patients were initiated on propranolol as first-line treatment; the fourth had comorbidities which precluded this. Of the three, two showed improvement, while a third, who also had bearded hemangioma, required tracheotomy. Infantile subglottic hemangiomas are rare but essential in the differential diagnosis of biphasic stridor. Although propranolol has been effective in treating cutaneous and airway hemangiomas, our experience suggests that this is not consistent for subglottic hemangiomas. In an area where airway compromise can be lethal, we must extend caution and monitor these patients closely as they may require adjuvant therapy.
    Full-text · Article · Sep 2011 · International journal of pediatric otorhinolaryngology
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    • "However, such therapy requires administration of systemic propranolol for at least 2 months, with possible side effects requiring careful clinical monitoring. In addition, various complications have been reported with systemic propranolol therapy.13–16 "
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    ABSTRACT: The purpose of this study was to evaluate the use of intralesional propranolol injection in the management of periocular capillary hemangioma. A prospective study was performed in 22 consecutive patients with periocular hemangioma. Twelve patients underwent intralesional propranolol injection and ten patients underwent intralesional triamcinolone injection. The size of the lesion was measured serially every week during the first month, every 2 weeks for the second month, and then monthly for another 2 months. The refractive error and degree of ptosis if present were measured before injection and at the end of the study. There was reduction in the size of hemangioma, astigmatic error, and degree of ptosis in both groups. The difference in outcome between both groups was not statistically significant. Rebound growth occurred in 25% of the propranolol group and 30% of the steroid group but responded to reinjection. No adverse effects were reported during or after intralesional propranolol injection. Intralesional propranolol injection is an alternative and effective method for treatment of infantile periocular hemangioma.
    Full-text · Article · Aug 2011 · Clinical Ophthalmology
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