Propranolol
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Various toxicities in infants: 10 case reports In a retrospective review of 32 infants with posterior fossa, haemangioma, arterial lesions, cardiac abnormalities or aortic coarctation and eye abnormalities (PHACE syndrome), ten infants [sexes not stated] were identified after they developed various toxicities while receiving propranolol [times to reaction onsets not stated]. The infants, who had PHACE syndrome with cervical and intracranial arterial anomalies, were between 2 weeks and 19 months of age when they started receiving oral propranolol 1.0–3.0 mg/kg/day, divided either two or three times daily. The duration of propranolol treatment was 5–18 months. During therapy, two patients experienced sleep disturbance and one patient developed night terrors. Four patients experienced GI upset, asymptomatic hypotension, constipation and periodic cold hands and feet, respectively. Two patients developed worsening of skin ulceration and tissue necrosis. One of these infants experienced worsening of scalp ulceration, as well as extensive deep facial and neck ulceration that took several months to heal, and ear ulceration that destroyed the upper half of the ear. Another infant experienced worsening of peripheral arteriopathy, with digital infarction, marked acrocyanosis and nail dystrophy, as well as severe sleep disturbance. Propranolol was decreased for three patients. One of these infants, who had developed hypotension during therapy, had normal vital signs on follow-up, while another infant with worsened skin ulceration had completely healed by 1 year of age. In the third infant, who had developed worsened peripheral arteriopathy, propranolol was later increased to the starting dosage without worsening of skin changes. At last follow-up, this infant had improved nail dystrophy and acrocyanosis, and there was no digit loss. One infant, who had developed mild sleep disturbance during treatment, discontinued propranolol after 8 months of therapy due to progressive vessel stenosis; propranolol was later restarted without incident. Four infants were still receiving propranolol at last follow-up [remaining patient outcomes not stated]. Author comment: "[P]ropranolol-induced effects on peripheral vasculature, including low cardiac output and unopposed alpha-adrenergic drive, result in low extremity blood flow, leading to the commonly observed side effects of cold extremities and Raynaud’s phenomenon." Metry D, et al. Propranolol use in PHACE syndrome with cervical and intracranial arterial anomalies: Collective experience in 32 infants. Pediatric Dermatology 30: 71-89, No. 1, Jan-Feb 2013. Available from: URL: http://dx.doi.org/10.1111/ 803086433 j.1525-1470.2012.01879.x - USA
0114-9954/10/1451-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 11 May 2013 No. 1451
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