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Selective and other beta-blocker therapy
Source: Childhood Vascular Tumors Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 17, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary.
Context: Benign Tumors / Infantile Hemangioma / Treatment of infantile hemangioma
Because of the nonselective and lipophilic nature of propranolol and its ability to cross the blood-brain barrier, other beta-blockers are being used for the treatment of infantile hemangiomas.
Evidence (beta-blocker therapy):
In two small comparison studies, there was no difference in efficacy between propranolol and atenolol.[120,121]
In support of a previous retrospective study, a prospective double-blind study compared nadolol with propranolol in 71 infants (aged 1–6 months).[122][Level of evidence A3]
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In support of a previous retrospective study, a prospective double-blind study compared nadolol with propranolol in 71 infants (aged 1–6 months).[122][Level of evidence A3]
The study demonstrated noninferiority with respect to efficacy and treatment.
A prospective study of 76 infants treated with atenolol noted efficacy and safety similar to propranolol.[123][Level of evidence C3]
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In one published report, nadolol was associated with the death of an infant (aged 17 weeks) after 10 days of no stool output.[124] There is limited information about the pharmacokinetics and safety of nadolol in infants. The drug has a narrow therapeutic index, and it is excreted and remains unchanged in the feces. If an infant is given nadolol, it is critical to monitor for regular stool output.
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Additional studies are needed to assess differences between the toxicities of these agents and the toxicities of propranolol.
There is some suggestion that the more selective beta-blockers have fewer side effects.[125] A study has suggested that the R(+) enantiomer of propranolol, carried over in drug synthesis rather than the anti–beta-adrenergic L(-) enantiomer (commercially available drug is a racemic mixture), may carry the therapeutic anti-infantile hemangioma effect.[89,90]
Publication references
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Preserved source evidence · Not medical advice