PURPOSE: The successful use of nadolol as an alternative to propranolol therapy 
in three cases of infantile hemangioma is reported.
SUMMARY: Infantile hemangioma is a benign vascular neoplastic disorder that 
affects up to 10% of newborns and can lead to deformity or local complications 
in severe cases. Propranolol, administered alone or in combination with 
corticosteroids, is increasingly used to treat infantile hemangioma, but its 
ability to cross the blood-brain barrier and potentially cause central nervous 
system adverse effects has prompted research on alternative β-blocker therapies 
for the disorder that have more favorable safety profiles, including nadolol. 
This article describes the use of nadolol to treat three pediatric patients with 
a buccal or genital hemangioma who developed adverse reactions (mainly, 
irritability and sleep disturbances) or resistance to initial treatment with 
propranolol. The patients were 10 months, 12 months, and 4 years of age, 
respectively, when hemangioma treatment was initiated. The results of nadolol 
therapy were favorable, with involution of lesions and gradual disappearance of 
propranolol-associated adverse effects occurring in all three cases. As with any 
use of β-blocker therapy in a pediatric patient, a cardiac workup is advised 
before the start of nadolol therapy; blood pressure and heart rate monitoring 
should be performed at one and two hours after the first dose and continued 
during dose escalation.
CONCLUSION: Nadolol was an effective alternative to propranolol in three 
pediatric patients with hemangiomas.