Propranolol

Calcium channel blockers and digoxin (Lanoxin) can lower of blood pressure and heart rate to dangerous levels when administered together with propranolol. Propranolol can mask the early warning symptoms of low blood sugar (hypoglycemia) and should be used with caution in patients receiving treatment for diabetes. Propranolol reduces the metabolism of thioridazine (Mellaril), increasing the concentration of thioridazine in the body and potentially causing abnormal heart beats.

Propranolol may be found in some form under the following brand names:

• Inderal

• Inderide

• InnoPran

In the U.S.

• Hemangeol
• Inderal
• Inderal LA
• Inderal XL
• InnoPran XL
• Propranolol HCl Intensol

Available Dosage Forms:

• Tablet
• Capsule, Extended Release
• Solution

Therapeutic Class: Cardiovascular Agent

Pharmacologic Class: Beta-Adrenergic Blocker, Nonselective

Propranolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure may reduce the risk of stroke and heart attacks.

Propranolol is also used to treat severe chest pain (angina), migraine headaches, or hypertrophic subaortic stenosis (thickened heart muscle).

propranolol may also be used to treat irregular heartbeats, tremors, or pheochromocytoma (adrenal gland tumor). It may also be used to reduce the risk of death in patients who have heart attacks.

Propranolol oral solution is used to treat proliferating infantile hemangioma.

propranolol is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

propranolol is available only with your doctor's prescription.

Take propranolol only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Your dose may need to be changed several times in order to find out what works best for you.

propranolol should come with a Medication Guide and patient directions. Read and follow these instructions carefully. Ask your doctor if you have any questions.

In addition to the use of propranolol, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that propranolol will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Swallow the long-acting oral capsules whole. Do not chew, crush, or open them.

Propranolol extended-release capsules should be taken at bedtime (10 p.m.). propranolol may be taken with or without food. However, you should take it the same way each time.

Measure the concentrated oral solution, Intensol™ with the dropper that comes with the package. You may mix the concentrated solution with water, juice, soda, applesauce, or pudding to make it easier to swallow, then take the mixture right away.

Measure the oral liquid with the dosing syringe that comes with the package. It should be given directly into the child's mouth, during or right after eating or breastfeeding. It may also be mixed with a small amount of milk or fruit juice and given with a baby's bottle. Do not shake before use.

Dosing

The dose of propranolol will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of propranolol. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For acute heart attack:
  • For oral dosage form (solution):
    • Adults—180 to 240 milligrams (mg) per day, given in divided doses.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—At first, 40 milligrams (mg) three times a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.
• For adrenal gland tumor (pheochromocytoma):
  • For oral dosage form (solution):
    • Adults—60 milligrams (mg) per day, given in divided doses for 3 days before having surgery. In patients who cannot have surgery, the usual dose is 30 mg per day, given in divided doses.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—60 milligrams (mg) per day, given in divided doses for 3 days before having surgery. In patients who cannot have surgery, the usual dose is 30 mg per day, given in divided doses.
    • Children—Use and dose must be determined by your doctor.
• For chest pain (angina):
  • For oral dosage form (long-acting oral capsules):
    • Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (solution):
    • Adults—80 to 320 milligrams (mg) per day, given in divided doses.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—80 to 320 milligrams (mg) per day, given in divided doses.
    • Children—Use and dose must be determined by your doctor.
• For high blood pressure (hypertension):
  • For oral dosage form (extended-release capsules):
    • Adults—At first, 80 milligrams (mg) once a day, given at bedtime. Your doctor may increase your dose if needed. However, the dose is usually not more than 120 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (long-acting oral capsules):
    • Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (solution):
    • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.
• For hypertrophic subaortic stenosis (thickened heart muscle):
  • For oral dosage form (long-acting oral capsules):
    • Adults—80 to 160 milligrams (mg) once a day.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (solution):
    • Adults—20 to 40 milligrams (mg) three or four times a day, given before meals and at bedtime.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—20 to 40 milligrams (mg) three or four times a day, given before meals and at bedtime.
    • Children—Use and dose must be determined by your doctor.
• For irregular heartbeats:
  • For oral dosage form (solution):
    • Adults—10 to 30 milligrams (mg) three or four times a day, given before meals and at bedtime.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—10 to 30 milligrams (mg) three or four times a day, given before meals and at bedtime.
    • Children—Use and dose must be determined by your doctor.
• For migraine headaches:
  • For oral dosage form (long-acting oral capsules):
    • Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (solution):
    • Adults—At first, 80 milligrams (mg) per day, given in divided doses. Your doctor may increase your dose if needed.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—At first, 80 milligrams (mg) per day, given in divided doses. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.
• For proliferating infantile hemangioma:
  • For oral dosage form (solution):
    • Children 5 weeks to 5 months of age—Dose is based on your child's body weight and must be determined by the doctor. The starting dose is usually 0.6 milligram (mg) per kilogram (kg) of your child's body weight two times a day, taken at least 9 hours apart. Give the dose during or immediately after a feeding. Do not administer the dose if the infant is vomiting or not eating. After 1 week, the doctor will increase the dose to 1.1 mg per kg of body weight two times a day. After 2 weeks, the doctor will increase the dose to 1.7 mg per kg of body weight two times a day, taken for 6 months.
    • Children under 5 weeks of age—Use is not recommended.
• For tremors:
  • For oral dosage form (solution):
    • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
    • Children—Dose is based on body weight and must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of propranolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Throw away any unused Hemangeol™ after 2 months.

Hypertension

Propranolol Hydrochloride Extended-Release Capsules, USP, are indicated in the management of hypertension. They may be used alone or used in combination with other antihypertensive agents, particularly a thiazide diuretic. Propranolol Hydrochloride Extended-Release Capsules, USP, are not indicated in the management of hypertensive emergencies.

Angina Pectoris Due to Coronary Atherosclerosis

Propranolol Hydrochloride Extended-Release Capsules, USP, are indicated to decrease angina frequency and increase exercise tolerance in patients with angina pectoris.

Migraine

Propranolol Hydrochloride Extended-Release Capsules, USP, are indicated for the prophylaxis of common migraine headache. The efficacy of Propranolol in the treatment of a migraine attack that has started has not been established, and Propranolol is not indicated for such use.

Hypertrophic Subaortic Stenosis

Propranolol Hydrochloride Extended-Release Capsules, USP, improve NYHA functional class in symptomatic patients with hypertrophic subaortic stenosis.

Propranolol is not significantly dialyzable. In the event of overdosage or exaggerated response, the following measures should be employed:

General

If ingestion is or may have been recent, evacuate gastric contents, taking care to prevent pulmonary aspiration.

Supportive Therapy

Hypotension and bradycardia have been reported following Propranolol overdose and should be treated appropriately. Glucagon can exert potent inotropic and chronotropic effects and may be particularly useful for the treatment of hypotension or depressed myocardial function after a Propranolol overdose. Glucagon should be administered as 50-150 mcg/kg intravenously followed by continuous drip of 1-5 mg/hour for positive chronotropic effect. Isoproterenol, dopamine or phosphodiesterase inhibitors may also be useful. Epinephrine, however, may provoke uncontrolled hypertension. Bradycardia can be treated with atropine or isoproterenol. Serious bradycardia may require temporary cardiac pacing.

The electrocardiogram, pulse, blood pressure, neurobehavioral status and intake and output balance must be monitored. Isoproterenol and aminophylline may be used for bronchospasm.

To report SUSPECTED ADVERSE REACTIONS contact AvKARE, Inc. at 1-855-361-3993; email drugsafety@avkare.com; or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Management of hypertension; angina pectoris; pheochromocytoma; essential tremor; supraventricular arrhythmias (such as atrial fibrillation and flutter, AV nodal re-entrant tachycardias), ventricular tachycardias (catecholamine-induced arrhythmias, digoxin toxicity); prevention of myocardial infarction; migraine headache prophylaxis; symptomatic treatment of obstructive hypertrophic cardiomyopathy (formerly known as hypertrophic subaortic stenosis); treatment of proliferating infantile hemangioma requiring systemic therapy (Hemangeol only)

Guideline recommendations:

Hypertension: The 2014 guideline for the management of high blood pressure in adults (JNC 8) recommends initiation of pharmacologic treatment to lower blood pressure for the following patients (JNC8 [James 2013]):

• Patients ≥60 years of age, with systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg. Goal of therapy is SBP <150 mm Hg and DBP <90 mm Hg.

• Patients <60 years of age, with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years of age with diabetes, with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years of age with chronic kidney disease (CKD), with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

Chronic kidney disease (CKD) and hypertension: Regardless of race or diabetes status, the use of an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) as initial therapy is recommended to improve kidney outcomes. In the general nonblack population (without CKD) including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or ARB. In the general black population (without CKD) including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel blocker instead of an ACEI or ARB. Beta-blockers are no longer recommended as first-line therapy in the general patient population.

Coronary artery disease (CAD) and hypertension: The American Heart Association, American College of Cardiology, and American Society of Hypertension (AHA/ACC/ASH) 2015 scientific statement for the treatment of hypertension in patients with CAD recommends the use of a beta blocker as part of a regimen in patients with hypertension and chronic stable angina with a history of prior MI. A BP target of <140/90 mm Hg is reasonable for the secondary prevention of cardiovascular events. A lower target BP (<130/80 mm Hg) may be appropriate in some individuals with CAD, previous MI, stroke or transient ischemic attack, or CAD risk equivalents (AHA/ACC/ASH [Rosendorff 2015]).

Hypersensitivity to propranolol, beta-blockers, or any component of the formulation; uncompensated congestive heart failure (unless the failure is due to tachyarrhythmias being treated with propranolol), cardiogenic shock; severe sinus bradycardia, sick sinus syndrome, or heart block greater than first-degree (except in patients with a functioning artificial pacemaker); bronchial asthma

Hemangeol (additional contraindications): Premature infants with corrected age <5 weeks; infants weighing <2 kg; heart rate <80 bpm; blood pressure <50/30 mm Hg; pheochromocytoma; history of bronchospasm

Canadian labeling: Additional contraindications (not in US labeling): Cor pulmonale; allergic rhinitis during pollen season; patients prone to hypoglycemia; hypotension (blood pressure parameters not specified in labeling); metabolic acidosis; vasospastic angina (also referred to as Prinzmetal angina or variant angina); severe peripheral arterial circulatory disturbance

Hemangiol (additional contraindications): Infants weighing <2.5 kg; breastfed infants if mother is treated with medicines contraindicated with propranolol; heart rate <100 bpm or blood pressure <65/45 mm Hg (<3 months of age), heart rate <90 bpm or blood pressure <70/50 mm Hg (3 to <6 months of age), heart rate <80 bpm or blood pressure <80/55 mm Hg (6 to 12 months of age)

There are no dosage adjustments provided in the manufacturer’s labeling. However, renal impairment increases systemic exposure to propranolol. Use with caution.

Not dialyzable (0% to 5%); supplemental dose is not necessary.

Peritoneal dialysis effects: Supplemental dose is not necessary.

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience constipation, abdominal cramps, diarrhea, fatigue, loss of strength and energy, nausea, vomiting, or insomnia. Have patient report immediately to prescriber severe dizziness, passing out, angina, confusion, hallucinations, memory impairment, mood changes, burning or numbness feeling, vision changes, shortness of breath, excessive weight gain, swelling of arms or legs, bruising, bleeding, bradycardia, abnormal heartbeat, sensation of cold, sexual dysfunction, signs of low blood sugar (dizziness, headache, fatigue, feeling weak, shaking, tachycardia, confusion, increased hunger, or sweating), signs of lupus (rash on the cheeks or other body parts, sunburn easy, muscle or joint pain, angina or shortness of breath, or swelling in the arms or legs), or signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes) (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Usual Adult Dose of Propranolol for Hypertension:

Initial dose:
Immediate-release: 40 mg propranolol orally 2 times a day
Sustained-release: 80 mg orally once a day
XL sustained-release: 80 mg orally once a day at bedtime
Maintenance dose:
Immediate-release: 120 to 240 mg orally per day
Sustained-release: 120 to 160 mg orally per day
XL sustained-release: 80 to 120 mg orally once a day at bedtime
Maximum dose:
IR/SR: 640 mg orally per day
XR: 120 mg orally per day

Comments:
-The XL sustained-release formulation should be administered once daily at bedtime (approximately 10 PM) and should be taken consistently either on an empty stomach or with food.
-Dose titration should be done gradually until adequate blood pressure control is achieved.
-The recommended dosing is the same whether used alone or added to a diuretic.
-The time needed for full hypertensive response to a given dosage is variable and may range from a few days to several weeks.
-While twice daily dosing of the immediate release formulation is effective and can maintain a reduction in blood pressure throughout the day, some patients, especially when lower doses are used, may experience a modest rise in blood pressure toward the end of the 12 hour dosing interval. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day. If control is not adequate, a larger dose, or 3 times daily therapy may achieve better control.

Usual Adult Dose of Propranolol for Angina Pectoris:

Immediate-release: Total daily doses of 80 to 320 mg orally 2 to 4 times a day have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG.
Sustained-release: Initial dose: 80 mg orally once a day. Dosage should be gradually increased at 3 to 7 day intervals. The average optimal dosage appears to be 160 mg once a day.
Maximum dose: 320 mg per day

Comments:
-If treatment is to be discontinued, dosage should be reduced gradually over a period of a few weeks.

Usual Adult Dose for Arrhythmias:

Immediate-release: 10 to 30 mg propranolol orally 3 to 4 times a day, before meals and at bedtime
IV: 1 to 3 mg at a rate not exceeding 1 mg/min. Sufficient time should be allowed for the drug to reach the site of action even when a slow circulation is present. A second dose may be given after 2 minutes. Thereafter, additional drug should not be given in less than 4 hours.

Comments:
-IV administration is usually reserved for life-threatening arrhythmias or those occurring under anesthesia.
-IV doses should be administered under careful monitoring, such as electrocardiography, and central venous pressure.
-The rate of IV administration should not exceed 1 mg (1 mL) per minute to decrease the possibility of lowering blood pressure and causing cardiac standstill.
-Transfer from IV to oral therapy should be considered as soon as possible.

Usual Adult Dose of Propranolol for Myocardial Infarction:

Immediate-release:
Initial dose: 40 mg orally 3 times a day for 1 month, then increase to 60 to 80 mg orally 3 times a day as tolerated.
Maintenance dose: 180 mg to 240 mg orally per day in divided doses (2 to 4 times daily)
Maximum dose: 240 mg orally per day

Usual Adult Dose for Migraine Prophylaxis:

Immediate-release:
Initial dose: 80 mg orally per day in divided doses
Maintenance dose: 160 to 240 mg orally per day in divided doses
Sustained-release:
Initial dose: 80 mg orally once a day
Maintenance dose: 160 to 240 mg once a day

Comments:
-The dosage should be increased gradually to achieve optimum migraine prophylaxis. If a satisfactory response is not obtained within 4 to 6 weeks after reaching the maximum dose, therapy should be discontinued.
-Withdrawal of therapy should be accomplished over a period of several weeks.

Usual Adult Dose of Propranolol for Benign Essential Tremor:

Immediate-release:
Initial dose: 40 mg propranolol orally 2 times a day
Maintenance dose: 120 to 320 mg orally per day

Comments:
-OptiPropranolol um reduction of essential tremor is usually achieved with a dose of 120 mg orally per day.
-Occasionally, it may be necessary to administer 240 to 320 mg orally per day.

Usual Adult Dose for Aortic Stenosis:

Immediate-release: 20 to 40 mg orally 3 to 4 times a day, before meals and at bedtime
Sustained-release: 80 to 160 mg orally once a day

Use: Hypertrophic Subaortic Stenosis

Usual Adult Dose of Propranolol for Pheochromocytoma:

Immediate-release:
Preoperatively: 60 mg orally daily in divided doses for 3 days prior to surgery as adjunctive therapy to alpha-adrenergic blockade
Management of Inoperable Tumor: 30 mg propranolol orally daily in divided doses as adjunctive therapy to alpha-adrenergic blockade

Usual Adult Dose for Atrial Fibrillation:

Immediate-release: 10 mg to 30 mg orally 3 or 4 times a day before meals and at bedtime

Usual Pediatric Dose for Arrhythmias:

Oral: Children: Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 8 hours; titrate dosage upward every 3 to 5 days; usual dose: 2 to 4 mg/kg/day; higher doses may be needed; do not exceed 16 mg/kg/day

IV: Children: 0.01 to 0.1 mg/kg slow IV over 10 minutes; maximum dose: 1 mg (infants); 3 mg (children)

Usual Pediatric Dose of Propranolol for Hypertension:

Children:
Immediate release formulations:
Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 12 hours; increase gradually every 5 to 7 days
Usual dose: 1 to 5 mg/kg/day
Maximum dose: 8 mg/kg/day

Children and Adolescents 1 to 17 years:
Immediate release formulations:
Initial: 1 to 2 mg/kg/day divided in 2 to 3 doses/day; titrate dose to effect
Maximum dose: 4 mg/kg/day up to 640 mg/day; sustained release formulation may be dosed once daily (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents).

Usual Pediatric Dose for Thyrotoxicosis:

Neonates: Oral: 2 mg/kg/day in divided doses every 6 to 12 hours; occasionally higher doses may be required

Adolescents: Oral: 10 to 40 mg/dose every 6 hours

Usual Pediatric Dose for Hemangioma:

Propranolol oral solution 4.28 mg/mL:
Initiate treatment at ages 5 weeks to 5 months:
Initial dose: 0.15 mL/kg (0.6 mg/kg) orally 2 times a day (at least 9 hours apart)
-After 1 week: Increase the daily dose to 0.3 mL/kg (1.1 mg/kg) orally 2 times a day (at least 9 hours apart)
-After 2 weeks: Increase the dose to 0.4 mL/kg (1.7 mg/kg) orally 2 times a day (at least 9 hours apart) maintain for 6 months

Comments:
-Dose should be periodically adjusted as the weight of the child increases.
-Administration directly into the mouth of the child is recommended; however, the product may be diluted in a small quantity of milk or fruit juice, given in a bottle.
-This drug should be administered during or right after a feeding to reduce the risk of hypoglycemia.
-The dose should be skipped if the child is not eating or is vomiting.
-Heart rate and blood pressure should be monitored for 2 hours after drug initiation or dose increases.
-If hemangiomas recur, treatment may be reinitiated.

Uses: For the treatment of proliferating infantile hemangioma requiring systemic therapy.

Propranolol oral solution 4.28 mg/mL:
Initiate treatment at ages 5 weeks to 5 months:
Initial dose: 0.15 mL/kg (0.6 mg/kg) orally 2 times a day (at least 9 hours apart)
-After 1 week: Increase the daily dose to 0.3 mL/kg (1.1 mg/kg) orally 2 times a day (at least 9 hours apart)
-After 2 weeks: Increase the dose to 0.4 mL/kg (1.7 mg/kg) orally 2 times a day (at least 9 hours apart) maintain for 6 months

Comments:
-Dose should be periodically adjusted as the weight of the child increases.
-Administration directly into the mouth of the child is recommended; however, the product may be diluted in a small quantity of milk or fruit juice, given in a bottle.
-This drug should be administered during or right after a feeding to reduce the risk of hypoglycemia.
-The dose should be skipped if the child is not eating or is vomiting.
-Heart rate and blood pressure should be monitored for 2 hours after drug initiation or dose increases.
-If hemangiomas recur, treatment may be reinitiated.

Uses: For the treatment of proliferating infantile hemangioma requiring systemic therapy.

Propranolol is not significantly dialyzable.