A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma (response)


Arturo Tozzi, MD, PhD

ASL Napoli 2 Nord, Naples, Italy


University of North Texas, Dept. of Physics, Center for nonlinear Science, Denton, Texas


Cite as:  Tozzi A.  Oral Propranolol for Infantile Hemangioma.  N Engl J Med 2015; 373:284-285July 16, 2015DOI: 10.1056/NEJMc1503811


The paper by Léauté-Labrèze et al. emphasizes the therapeutic efficacy and the short-term safety of propranolole in the treatment of infantile hemangiomas.  However, recent studies raise concerns regarding the potentially relevant long-term neurodevelopmental or cognitive side-effects of the highly lipophilic propranolol (1).   Indeed, lipophilic beta-blockers cross the blood–brain barrier, leading to sleep and memory disturbance (2).  To give some examples, sleep disturbance, somnolence and irritability have been observed in a significant number of infants treated with the propranolol (3), while it has been shown that such a drug decreases specific memory functions in adults (4).  A recent review suggests that it appears conceivable that blockage of neural pathways critical for learning and memory could be an unrecognized long-term side-effect of propranolol in infants (5).

Further long-term studies are thus needed before to routinely suggest the use of the propranolol in the treatment of infantile hemangiomas.



1 Langley A, Pope E. Propranolol and central nervous system function: potential implications for paediatric patients with infantile haemangiomas. Br J Dermatol 2015; 172:13–23.

2 McAinsh J, Cruickshank JM. Beta-blockers and central nervous system side effects. Pharmacol Ther 1990; 46:163–97.

3 Solman L, Murabit A, Gnarra M et al. Propranolol for infantile haemangiomas: single centre experience of 250 cases and proposed therapeutic protocol. Arch Dis Child 2014; 99:1132–6.

4 Kroes MC, Strange BA, Dolan RJ. Beta-adrenergic blockade during memory retrieval in humans evokes a sustained reduction of declarative emotional memory enhancement. J Neurosci 2010;30:3959–63.

5 Hoeger PH.  Propranolol for Infantile Haemangiomas: Certain Chances, Potential Risks.  The British Journal of Dermatology. 2015;172(1):3-4.