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Peds Calc

Pediatric Reference

Propranolol Side EffectsComprehensive Pediatric Safety Guide

Propranolol side effects stem from beta blockade and include bradycardia, hypotension, and hypoglycemia in infants.

4 Categories
5 Clinical Sources
Evidence-Based
Back to Propranolol Overview

Essential Information

1

Check heart rate before doses when advised.

2

Maintain regular feeding schedules to prevent hypoglycemia.

3

Report mood changes or nightmares in adolescents.

Clinical Overview

Monitor vitals and glucose especially during initiation and illness.

Side Effect Categories

4 Systems

Cardiovascular

2 documented effects

Total Sources: 2

Bradycardia

Incidence: Common
Onset: Not specified
moderate
1 sources
Duration

Not specified

Management

Hold dose if HR below target and contact clinician.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Hypotension

Incidence: Uncommon
Onset: Not specified
moderate
1 sources
Duration

Not specified

Management

Monitor BP; adjust dose if symptomatic.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Metabolic

1 documented effect

Total Sources: 1

Hypoglycemia (infants)

Incidence: Uncommon
Onset: Not specified
serious
1 sources
Duration

Not specified

Management

Hold doses during poor intake; educate caregivers on symptoms.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Respiratory

1 documented effect

Total Sources: 1

Bronchospasm

Incidence: Rare
Onset: Not specified
serious
1 sources
Duration

Not specified

Management

Stop drug and seek emergency care

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Neurologic

1 documented effect

Total Sources: 1

Fatigue/drowsiness

Incidence: Common
Onset: Not specified
mild
1 sources
Duration

Not specified

Management

Assess dosing schedule and adjust as needed.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Parent Communication Guide

Age-Appropriate Explanations

Infants (0-12 months)

Feed your baby just before each dose to prevent low blood sugar. Hold the dose and call if they are vomiting, not feeding well, or seem unusually sleepy or cold.

Toddlers (1-3 years)

If your toddler is sick and not eating, skip the propranolol dose and contact us. Tell caregivers to watch for pale skin, sweating, or shakiness.

Children (4-12 years)

This medicine keeps your heart steady. Sit or lie down if you feel dizzy, and let an adult know right away.

Adolescents (13+ years)

Check your pulse or blood pressure as instructed. Skip doses during vomiting illness, severe asthma flare, or before intense exercise until cleared by your clinician.

Common Parent Concerns

Q: Cold hands or feet

A: A common effect. Contact clinician if painful or persistent.

When to validate: Call if accompanied by numbness or color changes.

Q: Missed or vomited dose

A: Skip and resume at the next scheduled time—never double up.

When to validate: Call if two or more doses are missed or vomiting continues.

Q: Low blood sugar warning signs

A: Watch for sweating, shakiness, irritability, or unusual sleepiness—especially before feeds.

When to validate: Check glucose if you have a home meter and call immediately if symptoms appear or BG <70 mg/dL.

Clinical Decision Support

Severity Assessment Framework

Triage propranolol adverse effects focusing on hypoglycemia, bradycardia, hypotension, and bronchospasm.

Mild
Indicators: Resting heart rate within individualized target, mild fatigue or cool extremities, Blood glucose ≥70 mg/dL with no neuroglycopenic symptoms, No respiratory symptoms
Action: Continue therapy, reinforce feeding with doses, and recheck vitals/glucose at next scheduled review.
Moderate
Indicators: Bradycardia below target or symptomatic hypotension (dizziness, syncope), Blood glucose 60-69 mg/dL or suspected during illness, Mild wheeze or cough in child with reactive airway disease
Action: Hold further doses, obtain vitals and glucose, provide oral carbohydrates, consult cardiology/dermatology regarding dose reduction, and evaluate need for bronchodilator therapy.
Severe
Indicators: Syncope, seizures, or unresponsive state, Blood glucose <60 mg/dL with neuroglycopenic symptoms, Severe bronchospasm, respiratory distress, or heart block on ECG
Action: Activate emergency response, administer IV dextrose/glucagon per protocols, provide advanced airway/bronchodilator support, discontinue propranolol, and admit for monitoring.

Treatment Decision Guidelines

Immediate Discontinuation

  • • Symptomatic bradycardia or second/third-degree heart block
  • • Seizure or severe hypoglycemia related to dosing
  • • Bronchospasm requiring emergent bronchodilator or hospitalization

Consider Alternatives

  • • Recurrent low blood sugar despite adherence to feeding plan
  • • Asthma or congenital heart disease limiting beta-blocker tolerance
  • • Lifestyle conflicts (competitive sports) despite counseling

Dose Modification

  • • Gradual titration after illness, using weight-based adjustments
  • • Splitting total daily dose into smaller, more frequent dosing
  • • Review interactions (e.g., clonidine, calcium-channel blockers) and adjust accordingly

Clinical References

Propranolol•MedlinePlus (2024)Drug information
Propranolol for infantile haemangiomas•Medicines for Children (2024)Patient information
Propranolol Home Care Instructions•American Academy of Pediatrics (2024)Clinical guidance
Beta-Blocker Therapy in Children•American College of Cardiology (2017)Expert analysis

Frequently Asked Questions

Parent and clinician concerns about Propranolol