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Hemangeol

propranolol
Used for Hemangioma

Hemangeol (propranolol) is a beta blocker. It's used to treat hemangiomas (extra blood vessels in the skin) in infants younger than 1 year old. This medication is taken by mouth, typically twice a day. Your child's provider will determine the dose based on your child's body weight. Some side effects of this medication include sleep problems, bronchitis, and cold arms and legs.

Reviewed by:
reviewerKristianne Hannemann, PharmD
reviewerAllison Gourley, PharmD
Last reviewed on November 20, 2023
basics-icon

What is Hemangeol (propranolol)?

What is Hemangeol (propranolol) used for?

How Hemangeol (propranolol) works

Hemangeol (propranolol) is a non-selective beta blocker. It's thought to treat hemangiomas by tightening blood vessels so that there's less blood flow to the hemangiomas.

Drug facts

Common BrandsHemangeol
Drug ClassBeta blocker
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Side effects of Hemangeol (propranolol)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Sleep problems (16-18%)
  • Bronchitis (8-13%)
  • Cold arms or legs (7-8%)
  • Agitation (5-9%)
  • Diarrhea (5-6%)
  • Nightmare (2-6%)
  • Irritability (1-6%)
  • Sleepiness (1-5%)

Less Common Side Effects

  • Low appetite
  • Stomach pain
  • Itching
  • Hair loss

Hemangeol (propranolol) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Slow heart rate or low blood pressure: pale skin, cold arms or legs, blue or purple skin color, fainting
  • Breathing problems: wheezing, abnormal breathing, blue skin color
  • Stroke: weakness in one side of the body, sleepiness, feeding difficulty

Source: DailyMed

The following Hemangeol (propranolol) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

in children

Cough producing mucus

difficulty with breathing

tightness in the chest

Incidence not known

Abdominal or stomach pain and tenderness

black, tarry stools

blistering, peeling, or loosening of the skin

blood in the urine

bloody nose

bloody stools

blurred or loss of vision

body aches or pain

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

chest pain or discomfort

confusion about identity, place, and time

congestion

constipation

cough

cracks in the skin

crying

decreased awareness or responsiveness

decreased urine output

depersonalization

diarrhea

difficulty with swallowing

dilated neck veins

disturbed color perception

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

double vision

dryness or soreness of the throat

dysphoria

euphoria

extreme fatigue

fast, pounding, slow, or irregular heartbeat

fever and chills

general feeling of discomfort, illness, or weakness

hair loss

halos around lights

headaches

heavier menstrual periods

hoarseness

irregular breathing

lightheadedness, dizziness, or fainting

loss of heat from the body

mental depression

mimicry of speech or movements

muscle or joint pain

mutism

nausea

negativism

night blindness

noisy breathing

overbright appearance of lights

paleness or cold feeling in the fingertips and toes

paranoia

peculiar postures or movements, mannerisms, or grimacing

pinpoint red or purple spots on the skin

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

quick to react or overreact emotionally

rapidly changing moods

rectal bleeding

red skin lesions, often with a purple center

red, irritated eyes

red, swollen skin

reddening of the skin, especially around the ears

runny nose

scaly skin

seeing, hearing, or feeling things that are not there

severe sleepiness

short-term memory loss

skin irritation or rash, including rash that looks like psoriasis

skin rash, hives, or itching

sores, ulcers, or white spots in the mouth or on the lips

sweating

swelling of the eyes, face, fingers, feet, or lower legs

swollen glands

tender, swollen glands in the neck

tightness in the chest

tingling or pain in fingers or toes when exposed to cold

tunnel vision

unusual bleeding or bruising

unusual tiredness or weakness

voice changes

vomiting

weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

in children

Anxiety

dry mouth

hyperventilation

irritability

restlessness

shaking

sleepiness or unusual drowsiness

trouble sleeping

unusual dreams

Less common

in children

Decreased appetite

Incidence not known

Dry eyes

heartburn

loss of strength or energy

muscle weakness

pain or discomfort in the chest, upper stomach, or throat

stomach cramps

unusual drowsiness, dullness, or feeling of sluggishness

vivid dreams

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Pros and cons of Hemangeol (propranolol)

Pros

  • First choice treatment for infantile hemangiomas
  • Stored at room temperature, no need to refrigerate
  • Comes in a strawberry vanilla flavor

Cons

  • Must be taken for several months
  • Needs to be given with food
  • Not available as a lower-cost generic
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Pharmacist tips for Hemangeol (propranolol)

pharmacist
  • Always use the syringe that comes with Hemangeol (propranolol) to measure your child's dose. Never use household spoons, because this could cause you to give the wrong dose. If you lose the dosing syringe, ask your pharmacist for a new one.
  • Don't shake Hemangeol (propranolol) before measuring a dose.
  • If you see air bubbles after drawing up your child's dose, push the plunger up towards the bottle to remove them and then pull it back to the measured dose.
  • You need to give Hemangeol (propranolol) with food or right after a feeding. This can help lower the risk for low blood sugar levels.
  • It's best to give Hemangeol (propranolol) directly into your child's mouth, using the syringe. But if your child has a hard time taking the medication this way, then you can mix it with a small amount of milk or fruit juice and give it to your child in a bottle.
  • If your child spits up after taking Hemangeol (propranolol), don't try to give them more medication. Instead, skip the dose and wait until the next scheduled dose.
  • After each dose of Hemangeol (propranolol), clean the dosing syringe by rinsing it with tap water and then wipe the outside dry. Don't take the syringe apart, and don't use any soap. Never put the syringe in the dishwasher.
  • Mark your calendar so that you don't miss any of your child's scheduled appointments. Your child's provider will need to adjust the dose as your child's weight changes.
  • Store Hemangeol (propranolol) at room temperature. After 2 months, throw the open bottle away, even if there's still medication in the bottle.
  • If your child is sick, not eating well, or going through a growth spurt, let your provider know. They might ask you to temporarily stop giving Hemangeol (propranolol) because your child might be at higher risk for low blood sugar levels during these times.
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Common questions about Hemangeol (propranolol)

Research shows that after 6 months of treatment, 60% of babies who took Hemangeol (propranolol) had their hemangioma go away completely or almost completely, compared to 4% of babies who took a placebo. Keep in mind that the babies in this study didn't have any serious or life-threatening hemangiomas. Not every child will respond to Hemangeol (propranolol) in the same way. If you've questions about how well Hemangeol (propranolol) might work, talk with your child's provider.

Yes. Hemangeol (propranolol) is only FDA-approved for infants ages 1 year and younger. Keep in mind that treatment should be started between 5 weeks and 5 months old.

The best way to give Hemangeol (propranolol) is to draw up the medication with a syringe and give it to your child directly into their mouth. Hemangeol (propranolol) comes with a 5 mL dosing syringe that you'll use to measure your child's dose. To measure the dose, you'll insert the syringe into the syringe adaptor on the medication bottle, and then turn the bottle upside down. Pull back on the plunger until you get the dose prescribed by your child's provider. Turn the bottle upright and remove the dosing syringe. While your child is in an upright position, place the syringe on the inside of their cheek and slowly give the medication. If your child has a hard time taking the medication from the syringe, you can mix Hemangeol (propranolol) with a small amount of milk or juice and give it to your child in their bottle.

You should give Hemangeol (propranolol) twice a day with or after feeding, but make sure each dose is at least 9 hours apart. Giving the doses too close together could raise the risk of side effects.

It's best to give Hemangeol (propranolol) during or right after a feeding. This can help lower the risk of low blood sugar. If you child isn't eating or is vomiting, skip the dose.

The most common side effects of Hemangeol (propranolol) include problems sleeping, bronchitis, feeling cold in the arms and legs, agitation, and diarrhea. These aren't all of the possible side effects from Hemangeol (propranolol), so be sure to follow up with your child's provider to learn more.

Hemangeol (propranolol) can slow heart rate. In clinical studies, infants taking Hemangeol (propranolol) experienced a drop in heart rate by about 7 beats per minute. Your child's provider will ask you to measure your child's heart rate regularly, especially after starting treatment and any time there's a dose change Hemangeol (propranolol).

Hemangeol (propranolol) contains the same ingredient as propranolol (Inderal). But they come in different dosages or concentrations, and they don't treat the same conditions. Propranolol (Inderal) is available in higher doses to treat conditions such as high blood pressure, tremors, and chest pain. Hemangeol (propranolol) is available in a lower strength and is only FDA-approved to treat infantile hemangiomas.

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Risks and warnings for Hemangeol (propranolol)

Hemangeol (propranolol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Low blood sugar

  • Risk factors: Poor feeding | Infection | Vomiting | Stress | Cold temperature

Hemangeol (propranolol) can raise the risk of low blood sugar levels. It can also make it more difficult to notice signs and symptoms of low blood sugar in your child, such as sweating. Your provider might recommend that you skip giving Hemangeol (propranolol) to your child in situations when they're more likely to have low blood sugar levels, such as when they're ill or aren't eating well. If you notice your child shaking or being very sleepy, get medical help right away.

Slow heart rate and low blood pressure

Hemangeol (propranolol) can lower your child's heart rate, which can lead to low blood pressure. Your child's provider might ask you to check your child's heart rate and blood pressure more often after the first dose and any time the dose is raised. Let your child's provider know if your child's blood pressure drops below 50 mmHg (systolic) or heart rate drops to less than 80 beats per minute.

Breathing problems

In some rare cases, Hemangeol (propranolol) can tighten the airways and cause breathing problems. This medication shouldn't be used if your child has asthma or a history of breathing problems because of this risk. If you notice your child having trouble breathing or wheezing, get medical help right away.

Higher risk or worsening of heart failure

  • Risk factors: Congestive heart failure

Hemangeol (propranolol) shouldn't be used in infants with heart failure, because it can make symptoms worse.

Risk of stroke in certain infants

  • Risk factors: PHACE syndrome

Infants who have a rare condition called PHACE syndrome are at a higher risk of stroke after taking Hemangeol (propranolol). Your child's provider will evaluate them to make sure Hemangeol (propranolol) is safe for them to take.

Severe allergic reactions

  • Risk factors: History of severe allergic reaction

Beta blockers, like Hemangeol (propranolol), might cause epinephrine (Epipen) to not work as well in treating severe allergic reactions (anaphylaxis). Discuss all of your child's allergies with your provider and a plan on what to do if they experience an allergic reaction while taking Hemangeol (propranolol).

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Hemangeol (propranolol) dosage

Typical dosage for Hemangeol (propranolol)

Each 1 mL of solution contains 4.28 mg of propranolol. Your child's provider will determine the dose based on their body weight.

  • The typical starting dose is 0.15 mL/kg of body weight by mouth twice a day, at least 9 hour apart. After 1 week, your child's provider will raise the dose to 0.3 mL/kg twice a day. After 2 weeks, they'll raise the dose again to 0.4 mL/kg twice a day for 6 months.
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Interactions between Hemangeol (propranolol) and other drugs

Hemangeol (propranolol) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Hemangeol (propranolol). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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Hemangeol (propranolol) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Hemangeol (propranolol) will not be safe for you to take.

  • Premature infants with corrected age younger than 5 weeks old
  • Infants weighing less than 2 kg
  • Asthma or history of bronchospasm
  • Heart rate less than 80 beats per minute, greater than [first degree heart block](https://www.goodrx.com/health-topic/heart/heart-block-pacemakers, or worsening heart failure
  • Blood pressure less than 50/30 mmHg
  • Rare tumor called pheochromocytoma

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References

Best studies we found

Centers for Disease Control and Prevention. (2020). Spoons are for soup, milliliters are for medicine.

Hoover, L. (2019). Infantile hemangioma: AAP releases guideline for management. American Family Physician.

MedlinePlus. (2016). Pheochromocytoma.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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