Oral Nadolol for Children with Infantile Hemangiomas and Sleep Disturbances with Oral Propranolol

Pediatr Dermatol. Nov-Dec 2015;32(6):853-7. doi: 10.1111/pde.12686. Epub 2015 Oct 8.


Background/objective: Oral propranolol has been shown to be safe and effective in infants with infantile hemangioma (IH). Side effects such as sleep disturbances have been associated with propranolol. The aim of this study was to evaluate the efficacy and safety of oral nadolol in a small series of patients whose propranolol therapy was discontinued due to sleep disturbances.

Methods: A retrospective study of patients with IHs who were treated with oral nadolol due to propranolol-related sleep disturbances at a pediatric tertiary care center between July 2008 and March 2013. Clinical response to oral nadolol and disappearance of propranolol-related side effects were analyzed.

Results: A total of 97 patients presenting IH received oral propranolol. Nine patients (9.3%) developed sleep disturbances. Oral propranolol was discontinued in seven patients and switched to oral nadolol, with resolution of these side effects in 5 (71%) of the cases. One patient developed sleep disturbances again after four months of oral nadolol.

Limitations: The sample size was too small to draw generalizable conclusions and to draw any statistical inference as to the incidence of sleep disturbances with nadolol therapy.

Conclusions: The use of oral nadolol in the treatment of IH in our series of 7 patients, resolved the propranolol-related sleep disturbances in 5 (71%), while in one patient the symptoms recurred after 4 months of oral nadolol at a dose of 2 mg/kg/day. In most cases, switching beta-blockers did not compromise efficacy, and is recommended when sleep disturbance necessitates discontinuation of beta-blocker therapy of IH.

MeSH terms

  • Administration, Oral
  • Chi-Square Distribution
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Hemangioma, Capillary / congenital
  • Hemangioma, Capillary / drug therapy*
  • Hemangioma, Capillary / physiopathology
  • Humans
  • Infant
  • Male
  • Nadolol / administration & dosage*
  • Patient Safety
  • Prognosis
  • Propranolol / adverse effects
  • Propranolol / therapeutic use
  • Retrospective Studies
  • Skin Neoplasms / congenital
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / physiopathology
  • Sleep Wake Disorders / chemically induced*
  • Sleep Wake Disorders / physiopathology
  • Treatment Outcome
  • Withholding Treatment


  • Nadolol
  • Propranolol