{
  "schema_version": 1,
  "kind": "condition",
  "id": "haemangioma-or-lymphangioma",
  "name": "Haemangioma or Lymphangioma",
  "category": "chronic",
  "sources": "Hemangioma - StatPearls - NCBI Bookshelf (NBK538232) - https://www.ncbi.nlm.nih.gov/books/NBK538232/ · Lymphangioma - StatPearls - NCBI Bookshelf (NBK470333) - https://www.ncbi.nlm.nih.gov/books/NBK470333/ · HEMANGEOL (propranolol hydrochloride) oral solution, DailyMed label SetID b6f9dd2a-632b-87eb-70f0-b2064d7ed48a, Dosage and Administration · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD28 - condition scope only, no dose",
  "review_status": "reviewed",
  "verified_against": "HEMANGEOL (propranolol hydrochloride) oral solution, DailyMed label SetID b6f9dd2a-632b-87eb-70f0-b2064d7ed48a, Dosage and Administration · Hemangioma - StatPearls - NCBI Bookshelf (NBK538232) - https://www.ncbi.nlm.nih.gov/books/NBK538232/ · Lymphangioma - StatPearls - NCBI Bookshelf (NBK470333), Treatment / Management",
  "verified_date": "2026-09",
  "treatments": [
    {
      "id": 867,
      "generic": "Propranolol",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 10.0,
      "adult_dose": "Not applicable - infantile haemangioma is treated in infancy (see the paediatric dose). Lymphangioma is not treated with a systemic drug",
      "adult_duration": "Not applicable",
      "dose_source": "HEMANGEOL (propranolol hydrochloride) oral solution, DailyMed label SetID b6f9dd2a-632b-87eb-70f0-b2064d7ed48a, Dosage and Administration; first-line status and the 2 mg/kg/day figure from Hemangioma - StatPearls - NCBI Bookshelf (NBK538232) - https://www.ncbi.nlm.nih.gov/books/NBK538232/",
      "rationale": "Non-selective beta blocker. StatPearls: \"Most infantile hemangiomas do not require treatment because they resolve on their own. Complicated infantile hemangiomas requires treatment. Recently, beta blockers such as oral propranolol (2mg/kg/day) have been shown to be effective as first line therapy.\" The amounts and the titration come from the licensed paediatric product, whose only indication is proliferating infantile haemangioma requiring systemic therapy.",
      "cautions": [
        "Specialist-initiated. The licensed indication is a proliferating infantile haemangioma that needs systemic therapy - most infantile haemangiomas need no treatment at all because they resolve on their own, so the decision to start is the referral service's.",
        "RED FLAG - Contraindicated in a premature infant less than 5 weeks past the due date, an infant weighing less than 2 kg, asthma or any history of bronchospasm, a heart rate below 80 beats per minute, heart block greater than first degree, decompensated heart failure, a blood pressure below 50/30 mmHg, and phaeochromocytoma.",
        "Hypoglycaemia can happen at any time during treatment, and propranolol masks its adrenergic warning signs - particularly tachycardia, palpitations and sweating. Give it during or right after a feed, and skip the dose if the child is not eating or is vomiting.",
        "Monitor heart rate and blood pressure for 2 hours after the first dose and after every dose increase.",
        "Egypt lists no paediatric propranolol liquid. The register carries 10 mg and 40 mg tablets and a 1 mg/ml intravenous ampoule only, so the small milligram amounts an infant needs have to be prepared by a pharmacy rather than measured from a tablet at the bedside. Confirm how the dose will actually be made up before starting.",
        "If the haemangioma recurs after treatment stops, the label allows treatment to be re-started."
      ],
      "peds_mgkg_low": 0.6,
      "peds_mgkg_high": 1.7,
      "peds_max_mg": null,
      "peds_basis": "dose",
      "peds_unit": "mg",
      "peds_note": "Twice daily, at least 9 hours apart, and titrated - the low figure is the starting dose and the high figure the maintenance dose, not a range to pick from. The label: \"The recommended starting dose of HEMANGEOL is 0.15 mL/kg (0.6 mg/kg) twice daily, taken at least 9 hours apart. After 1 week, increase the daily dose to 0.3 mL/kg (1.1 mg/kg) twice daily. After 2 weeks of treatment, increase the dose to 0.4 mL/kg (1.7 mg/kg) twice daily and maintain this for 6 months.\" Treatment is initiated at ages 5 weeks to 5 months, and the dose is readjusted periodically as the child's weight increases. The two sources give different daily totals for maintenance: 1.7 mg/kg twice daily is the licensed figure, while StatPearls states 2 mg/kg/day; both are recorded here rather than one being chosen. Two bounds on the table above. The label contraindicates it in an \"infant weighing less than 2 kg\", which is the lower limit; and it states that \"Safety and effectiveness for infantile hemangioma have not been established in pediatric patients greater than 1 year of age\", which is why the table stops. The 12 kg ceiling is a bound derived from that one-year limit, not a weight the label itself states - a child heavier than this is outside the evidence for the drug in this condition, not merely off the end of a table.",
      "peds_min_weight_kg": 2.0,
      "peds_max_weight_kg": 12.0,
      "peds_age_min_months": null,
      "peds_age_max_months": 12.0,
      "peds_age_bands": null,
      "peds_doses": [
        {
          "weight_kg": 10,
          "low_mg": 6,
          "high_mg": 17,
          "capped": false
        }
      ],
      "brands": [
        {
          "trade_name": "INDOLOL 10 MG 50 TAB",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA",
          "price_egp": 12.5,
          "pack_count": 50,
          "unit_price": 0.25,
          "strength_mg": 10.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PROLOL 10 MG 50 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 16.25,
          "pack_count": 50,
          "unit_price": 0.33,
          "strength_mg": 10.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "INDERAL 10 MG 50 TABS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ASTRA ZENECA",
          "price_egp": 75.0,
          "pack_count": 50,
          "unit_price": 1.5,
          "strength_mg": 10.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "haemangioma-or-lymphangioma"
    },
    {
      "id": 868,
      "generic": "Recognition, monitoring and referral (Referral & Advice)",
      "line": 2,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Benign vascular or lymphatic malformations, often congenital, presenting as a raised birthmark that blanches on pressure. Most infantile haemangiomas involute on their own; larger or problematic lesions near the eye, airway or genitalia, or ones that ulcerate, are treated with the oral propranolol above under specialist supervision, so the GP's role is monitoring, timely referral, and continuing the prescription safely once it is started. A lymphangioma is a different problem with no systemic drug: the treatment of choice is surgical excision, with laser, cryotherapy, compression and sclerotherapy as the other reported options.",
      "adult_duration": "Refer, with advice",
      "dose_source": "No dose - a recognition and referral pathway. The lymphangioma statement is from Lymphangioma - StatPearls - NCBI Bookshelf (NBK470333), Treatment / Management",
      "rationale": "Benign vascular or lymphatic malformations, often congenital, presenting as a raised birthmark that blanches on pressure. Most infantile haemangiomas involute on their own; larger or problematic lesions near the eye, airway or genitalia, or ones that ulcerate, are treated with the oral propranolol above under specialist supervision, so the GP's role is monitoring, timely referral, and continuing the prescription safely once it is started. A lymphangioma is a different problem with no systemic drug: the treatment of choice is surgical excision, with laser, cryotherapy, compression and sclerotherapy as the other reported options.",
      "cautions": [
        "Recurrence after surgery for a lymphangioma is common - reported as high as 23% over follow-up of up to 81 months - so a lesion that comes back is not necessarily a failed operation.",
        "RED FLAG - Cellulitis and lymphatic fluid leakage are common complications of lymphangioma circumscriptum.",
        "RED FLAG - Large cystic hygromas of the neck can cause dysphagia and respiratory problems.",
        "RED FLAG - A haemangioma near the eye, airway, or genitalia (risk of function-threatening growth), ulceration or bleeding of the lesion, or rapid growth in early infancy needing specialist review before it enlarges further."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Both conditions usually present in infancy or childhood; the pathway is the same - recognise, monitor and refer. The propranolol row above carries the weight-based dose for the haemangioma.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "haemangioma-or-lymphangioma"
    }
  ]
}