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. 2024 Jul-Aug;41(4):621-627.
doi: 10.1111/pde.15623. Epub 2024 Apr 17.

Regimen for accelerated propranolol initial dosing (RAPID)

Charles Y Huang  1 , Marissa J Perman  2   3 , Albert C Yan  2   3
Affiliations

Regimen for accelerated propranolol initial dosing (RAPID)

Charles Y Huang et al. Pediatr Dermatol. 2024 Jul-Aug.

Abstract

Background: Infantile hemangiomas are common vascular tumors in children. Propranolol has proven effective in treating infantile hemangiomas and while generally safe, has potential risk for more serious side effects of hypoglycemia, hypotension, bradycardia, bronchospasm, and cardiovascular or respiratory compromise. Current prescribing guidelines recommend initiating propranolol doses at 1 mg/kg/day, with up-titration to 2 mg/kg/day. This study aims to compare the incidence of adverse events in infants and children treated with propranolol initiated at 1 mg/kg/day versus being initiated directly at 2 mg/kg/day.

Methods: A retrospective cohort study was conducted using medical records of patients receiving propranolol therapy for infantile hemangiomas between October 2018-March 2021 at the Children's Hospital of Philadelphia. Patients were categorized by initial propranolol dosage: 1 or 2 mg/kg/day. The primary outcome measures included parent-reported adverse events, hypotension (defined by the Pediatric Advanced Life Support criteria), and bradycardia (defined as <1st percentile for age) following propranolol initiation.

Results: Out of the 244 patients identified, 123 were initiated at the 1 mg/kg/day dose, and 121 at the 2 mg/kg/day dose. There was no significant difference in the incidence of adverse events between the two groups (p = .057). Additionally, among patients initiated at 2 mg/kg/day, there were no significant differences in the incidence of age-related or weight-related adverse events for those younger than 2 months or those in the 1st or 2nd quartile for weight (p = .53).

Conclusion: Infants and children initiated at 2 mg/kg/day did not demonstrate an increased incidence of adverse events associated with propranolol compared to those initiated at 1 mg/kg/day. These findings provide clinical evidence for the practice of accelerated propranolol initiation dosing.

Keywords: infantile hemangioma; propranolol.

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References

REFERENCES

    1. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009;26(5):610‐614. doi:10.1111/j.1525‐1470.2009.00975.x
    1. Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008;25(2):168‐173. doi:10.1111/j.1525‐1470.2008.00626.x
    1. Léauté‐Labrèze C, Hoeger P, Mazereeuw‐Hautier J, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372(8):735‐746. doi:10.1056/nejmoa1404710
    1. Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143(1):e20183475. doi:10.1542/peds.2018‐3475
    1. Morimoto A, Ozeki M, Sasaki S, Baba N, Kuwano Y, Kaneko T. Severe hypoglycemia in propranolol treatment for infantile hemangiomas. Pediatr Int. 2022;64(1):e15278. doi:10.1111/ped.15278

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