Propranolol Dosing Guidelines

Introduction to Propranolol Dosing

• The American Academy of Pediatrics recommends a propranolol dose of 2-3 mg/kg per day for pediatric patients with infantile hemangiomas, and 120-160 mg daily for adults with hypertension, angina, or migraine 1, 2

Pediatric Dosing

• For infantile hemangiomas, the recommended dose is 2-3 mg/kg per day, with a starting dose of 1 mg/kg per day and gradual titration 1, 2
• The FDA-approved formulation (Hemangeol) starts at 0.6 mg/kg twice daily, increasing over 2 weeks to a maintenance dose of 1.7 mg/kg twice daily (3.4 mg/kg/day total) 2
• A minimum of 6 months of therapy is superior to 3 months, with many experts recommending continuing until at least 1 year of age 1

Administration and Monitoring

• Propranolol should be administered with or after feeding, especially in pediatric patients, and doses should be held during times of diminished oral intake or vomiting to reduce hypoglycemia risk 1
• Blood pressure and heart rate should be monitored during treatment, particularly at initiation 3

Special Populations

• Lower doses may be required for patients with PHACE syndrome, sleep disturbances, or progressive infantile hemangioma ulceration while on therapy 1, 2
• For high-risk patients requiring treatment, the lowest effective dose should be used, with slow titration and consideration of administering 3 times daily to minimize blood pressure fluctuations 1, 2