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.
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.
Source:Â DailyMed
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:
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
cracks in the skin
crying
decreased awareness or responsiveness
decreased urine output
depersonalization
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
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
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
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
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
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
hyperventilation
irritability
restlessness
shaking
sleepiness or unusual drowsiness
trouble sleeping
unusual dreams
Less common
in children
Decreased appetite
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.
First choice treatment for infantile hemangiomas
Stored at room temperature, no need to refrigerate
Comes in a strawberry vanilla flavor
Must be taken for several months
Needs to be given with food
Not available as a lower-cost generic
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.
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.
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.
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.
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.
Risk factors: Congestive heart failure
Hemangeol (propranolol) shouldn't be used in infants with heart failure, because it can make symptoms worse.
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.
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).
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.
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.
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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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.
Morimoto, A., et al. (2022). Severe hypoglycemia in propranolol treatment for infantile hemangiomas. Pediatrics International.
National Organization for Rare Disorders. (2018). PHACE syndrome.
Pierre Fabre Pharmaceuticals, Inc. (2023). Hemangeol- propranolol hydrochloride solution [package insert]. DailyMed.
Sethuraman, G., et al. (2014). Management of infantile hemangiomas: Current trends. Journal of Cutaneous and Aesthetic Surgery.
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