Sir,
We read the excellent review by Spiteri Cornish and Reddy1 describing the management of periocular capillary haemangiomas using propranolol and the current available evidence supporting this.
Our experience in Southampton has been very positive. We have a cohort of seven patients (two orbital, four periocular, and one brow haemangioma). We used a starting dose of 1 mg/kg per day in three divided doses, increasing it to 2 mg/kg per day after 1 week if tolerated. Six of our patients have responded very well to the treatment and have had no side effects to date. The propranolol was stopped in one case owing to loss of appetite, which coincided with the commencement of propranolol.
One point we wished to make is to raise awareness of the fact that propranolol elixir can be dispensed in four concentrations (5 mg/5 ml, 10 mg/5 ml, 40 mg/5 ml and 50 mg/5 ml). We have had one drug error where the prescription was correctly written, but the dispensing community pharmacist gave the 50 mg/5 ml propranolol. This resulted in the infant being given 10 times the prescribed dose. He was admitted for monitoring with no ill effect. We feel it is important that parents are made aware of the different formulations available so that similar possible errors are prevented.
References
Spiteri Cornish K, Reddy AR . The use of propranolol in the management of periocular capillary haemangioma – a systematic review. Eye 2011; 25 (10): 1277–1283.
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Clifford, L., May, K. Reply to Spiteri Cornish and Reddy. Eye 26, 614–615 (2012). https://doi.org/10.1038/eye.2011.339
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DOI: https://doi.org/10.1038/eye.2011.339