Mary Wu Chang, MD reviewing Bernabeu-Wittel J et al. Pediatr Dermatol 2015 Nov.

This beta-blocker was helpful for hemangiomas in infants who experienced sleep disturbance with propranolol.

Propranolol is FDA approved for treatment of infantile hemangioma (IH), when treatment is needed (see NEJM JW Dermatol Aug 2011). Sleep disturbances (restless sleep, night terrors) are a known side effect of propranolol. Nadolol, a hydrophilic nonselective beta-blocker, was safe and effective for treatment of IH in a small study.

These investigators describe nadolol treatment of seven infants from a larger study who discontinued propranolol due to sleep disturbance. The median age at initiation of propranolol therapy was 5 months (range, 2–44 months); mean duration of propranolol at discontinuation was 4.8 +/- 3 months; and the mean dose was 2 mg/kg/day. Seven of nine patients who developed sleep disturbance were switched to oral nadolol solution (10 mg/mL), increasing gradually to 2 mg/kg/day. One patient received 4 mg/kg/day to achieve response. The mean duration of nadolol treatment was 5 +/- 3 months. In five, sleep disturbances resolved quickly. One patient's sleep issues resolved when nadolol was reduced to 1 mg/kg/day. Hemangiomas responded well: Complete response occurred in three patients, partial response in three, and IH regrowth in one. Baseline cardiology evaluation and electrocardiogram were followed by biweekly blood pressure and pulse assessment. Adverse effects were few: asymptomatic hypotension in one and partial bronchitis in two. The investigators conclude that nadolol should be considered if sleep disturbance limits propranolol therapy.

Citation(s):

Bernabeu-Wittel J et al. Oral nadolol for children with infantile hemangiomas and sleep disturbances with oral propranolol. Pediatr Dermatol 2015 Nov; 32:853.

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