Atenolol for haemangioma

Atenolol belongs to a group of medicines known as beta blockers which narrow blood vessels to haemangiomas. This reduces blood flow and increases softness to the haemangioma, as well as reducing it in size.

A haemangioma is a collection of immature blood vessels, sometimes called ‘strawberry marks’ because the surface of some haemangiomas looks a bit like a strawberry.

Haemangiomas can be superficial or deep in the skin. Some haemangiomas are a combination of the two, seen as a raised red area on the surface of the skin, and as a bluish swelling deeper in the skin. Very occasionally haemangiomas may occur internally.

Haemangiomas are not usually obvious at birth but become apparent within a few days or weeks. They grow rapidly in the first three months, increasing in size and sometimes in redness. It is unusual for haemangiomas to grow after six to ten months of age, when most haemangiomas tend to have a ‘rest period’ and then begin to shrink.

Haemangiomas have been well treated with a beta blocker called propranolol, but this medicine is occasionally not tolerated due to side effects. In this case atenolol may be used instead. It is less selective in its effect than atenolol and may not be suitable for some children such as those with frequent wheeziness. Atenolol may therefore sometimes be suggested as an alternative.

Atenolol is a selective beta-blocker. Some nerves release a chemical called noradrenaline when they are stimulated, which in turn stimulates ‘beta adrenergic receptors’. These can cause a variety of effects. For instance, if the beta adrenergic receptors in the heart are stimulated, the heart pumps harder and faster than before, so more blood is pumped around the body. Beta-blocker medicines block the beta adrenergic receptors and stop them being stimulated.

Atenolol is available as an oral solution, and as tablets. If your child is taking the oral solution, you should use an oral syringe to draw up the correct dose. These instructions will be on the medicine label. Tablets are available for older children which are usually taken once a day.

At GOSH, we supply atenolol as a 25mg/5ml liquid - that is 5ml of liquid contains 25mg of the active ingredient. Parents are asked to check the dose before giving it to their child.

The dose of atenolol is calculated on your child's weight so the dose will increase as they grow.

Treatment of haemangiomas with atenolol usually lasts until 14 to 18 months of age. When treatment is no longer needed, the dose of atenolol should be gradually reduced and not stopped suddenly.

Whilst taking atenolol, we advise giving your child frequent feeds during the day. Babies must be woken during the night to have a milk feed.

Atenolol is usually given once a day.

Most haemangiomas will have disappeared completely by the age of five to seven years. Large haemangiomas may continue to get smaller until your child is about 10 years old. Depending on the size and location of the haemangioma, there may be little sign it ever existed. For more information about the possible effects of a haemangioma, please see our Haemangiomas booklet.

Some children will be monitored for two hours after the first dose. This monitoring allows the doctors to be absolutely sure your child can tolerate the prescribed dose. The procedure is occasionally repeated after one week when the dose is increased, although the dose is normally increased at home.

Side effects are uncommon, but atenolol can cause:

• gastrointestinal disturbances such as constipation or diarrhoea
• slow heart rate or low blood pressure - signs of this may be dizziness or fainting
• cold extremities
• weakness and fatigue, such as floppiness and lack of interest in surroundings
• hypoglycaemia (low blood sugar)
• sleep disturbances
• wheezing or coughing

Occasionally we will suggest some tests to check that your child can safely take the medicine. These may include blood and urine tests, an electrocardiogram (ECG) and echocardiogram (Echo). If your child has multiple haemangiomas visible on the skin, we may also carry out an abdominal ultrasound scan to look for any haemangiomas in the liver.

If you have any concerns about these side effects, please discuss them with your doctor or pharmacist.

People with the following conditions should discuss taking atenolol with their doctor:

• asthma
• kidney disease
• hypotension (low blood pressure)
• diabetes or hypoglycaemia (low blood sugar)
• uncontrolled heart failure or heart block
• Raynaud's disease

The following medicines are known to interact with atenolol:

• other medicines which slow the heart rate such as digoxin, verapamil and diltiazem
• other medicines that reduce blood pressure such as diuretics, ACE inhibitors and calcium channel blockers
• lignocaine - an ingredient in some teething gels should not be given to babies taking atenolol
• your child should not have the anti-wheezing medicine salbutamol (by inhaler or nebuliser) while taking atenolol as the two medicines have opposing effects

Always check with your doctor or pharmacist before giving your child any other medicines, including herbal or complementary medicines.

• Keep medicines in a safe place where children cannot reach them.
• Keep medicines in a cool, dry place out of direct sunlight and away from heat.
• If your doctor decides to stop treatment with atenolol, return any unused medicine to your pharmacist. Do not flush down the toilet or throw it away.
• If you forget to give your child a dose, give it as soon as you remember. Do not give a double dose if it is already time to give the next one.
• Your family doctor (GP) will need to give you a repeat prescription for atenolol.
• Some medicines will need to be ordered by your local pharmacist - ask your GP for another prescription with enough time (when you have about 2 weeks of your medicine left) to ensure you do not run out.

For further information please contact:

Medicines Information: 020 7829 8608 or via the Medications page on the MyGOSH app (available Monday - Friday, 9am - 5pm)

Dermatology team via GOSH switchboard: 020 7405 9200 or via the MyGOSH app

Birthmark Unit 

Tel: 020 7405 9200 ext 1113

Support groups

The Birthmark Support Group offers support and advice to parents of children with all types of birthmark. Telephone their helpline on 0845 045 4700 or visit their website at www.birthmarksupportgroup.org.uk

Changing Faces is another organisation that will be able to offer help and support to anyone living with a condition that affects their appearance. Visit their website at www.changingfaces.org.uk or telephone their helpline on 0845 4500 275.