Khansa Plastic Surgery
Propranolol and Hemangeol for Hemangiomas in Austin, TX
Formulations of propranolol
What formulations of propranolol are there?
There are two main formulations of propranolol for hemangiomas in babies. Both medications have the same active ingredient, and both are believed to be equally effective. However, some babies may tolerate one formation better than the other, because of other, inactive ingredients.
Propranolol (generic) 4 mg/mL is the generic form of the medication. It is easier to get approved by insurance
Hemangeol (propranolol hydrochloride) 4.28 mg/mL is the brand-name version of the medication. Sometimes insurance requires that patients fail or not tolerate generic propranolol before approving Hemangeol
Propranolol
What are propranolol and Hemangeol?
Propranolol is a medication belonging to the beta-blocker class. Propranolol blocks the action of epinephrine and norepinephrine at the beta1 and beta2 receptors. Hemangeol is a specific brand-name of propranolol.
Beta1 receptors are present in the heart, and stimulate cardiac activity. As a result, propranolol can decrease heart rate and decrease blood pressure.
Beta2 receptors are present in blood vessel walls, and cause blood vessels to dilate. As a result, propranolol can increase blood pressure.
While propranolol can both increase and decrease blood pressure with its beta1 and beta2 activity, the overall effect is a decrease in blood pressure.
Uses
What are propranolol and Hemangeol used for?
Propranolol is a commonly used medication for various reasons, including:
Lowering blood pressure in people with high blood pressure (hypertension)
Preventing certain types of migraine headaches
Treating anxiety
Treating essential tremor (shaking)
Treating infantile hemangiomas
Propranolol for hemangiomas
How do propranolol and Hemangeol shrink hemangiomas?
Propranolol is the gold-standard medication for the treatment of infantile hemangiomas in the proliferative phase. It is believed to act on hemangiomas in part through inhibition of the Beta2 receptors that are present in blood vessel walls and in hemangioma cells. This causes the cells to divide less, causing hemangiomas to shrink. However, there are additional mechanisms by which propranolol shrinks hemangiomas that we don't fully understand yet.
Propranolol is most effective for hemangiomas that are in the proliferative phase. That means that, to achieve the best result, propranolol should be started early, while the hemangioma is growing rapidly.
Side effects of propranolol
What are potential side effects and precautions with propranolol and Hemangeol?
In general, propranolol and Hemangeol are safe for babies with hemangiomas. However, there are some precautions that must be followed:
Risk of bradycardia (low heart rate) and hypotension (low blood pressure) : because propranolol/Hemangeol is a medication that can lower heart rate and blood pressure, there is a risk of bradycardia and hypotension. To avoid those risks, parents must ensure that they are giving the exact prescribed dose, and that they are not giving doses too close to each other. Doses should be spaced by 8 hours. Do not make up missed doses. Instead, just wait for the next dose. If the baby spits out the medication, do not try give more medication to replace what the baby spat out. Instead, just wait until the next scheduled dose.
Risk of hypoglycemia (low blood sugar): propranolol/Hemangeol can lower blood sugar. For that reason, it should always be given at meal time. Dr. Khansa recommends giving some formula/milk/food, then the medication, then finishing the meal. Do not make up missed doses. Instead, just wait for the next dose. If the baby spits out the medication, do not try give more medication to replace what the baby spat out. Instead, just wait until the next scheduled dose.
Risk of airway spasm (wheezing): in children who have a history of asthma, reactive airway disease, wheezing or RSV, propranolol and Hemangeol can cause wheezing. If this happens, stop the medication and seek medical care immediately
Spitting up: sometimes, propranolol and Hemangeol can cause spit ups and/or reflux
Sleep disturbance: sometimes, propranolol and Hemangeol can affect the baby's sleep, with some babies sleeping more, and some babies sleeping less
Dr. Khansa will continue to monitor your child during treatment, and will be available to help or modify the treatment plan if side effects develop.
Indications propranolol
Does every infantile hemangioma need treatment with propranolol or Hemangeol?
Not every hemangioma needs treatment with propranolol or Hemangeol.
Most small hemangiomas do not require active intervention, as they will eventually naturally shrink on their own during the involution phase. Only hemangiomas that cause problems should be treated. Problems that may require treatment include:
Anatomic distortion / cosmetic disruption
Ulceration
Functional impairment
Visual obstruction
Airway obstruction
Rapid growth with concern for future functional or cosmetic disruption
Flat hemangiomas (hemangiomas that are not significantly raised) can be treated with topical timolol gel. However, if a hemangioma is thick, timolol will not be effective, and propranolol or Hemangeol are much more effective.
Dr. Khansa will be able to evaluate your child's hemangioma, and will guide you through the decision-making process to help determine whether treatment is necessary.
Why choose Khansa Plastic Surgery for hemangioma treatment in Austin?
Harvard Medical School graduate
Certified by the American Board of Plastic Surgery (ABPS)
2026 Austin Monthly Top Doctor
Over 70 peer-reviewed publications. World-renowned researcher.
Treats adults and children
Expert in all the different treatments of hemangiomas
Focuses on both cosmetic and functional concerns simultaneously
Evening and weekend consultations available
Conveniently located off the Mopac at 3305 Northland Dr., Suite 210, Austin, TX 78731
Schedule an appointment with Dr. Khansa
Check out other plastic surgery services offered by Dr. Khansa
Contact us
3305 Northland Dr, Suite 210, Austin, TX 78731
(512) 615-6566 (call or text)