Nancy's group at Childrens National has some data on this issue, and compared propeanolol to prednisolone. Can't locate the citation. I'm not in peds treatment or clinical research anymore.

US FDA has approved only systemic propranolol for the management of

haemangiomas.Dose can be up to 3mg/kg.

We almost  use the same dosage with satisfactory outcome.

We use 1 mg/kg q12h or q8h. Interestingly, when you put the hemangioma cell in culture we found a dose of 10-100 fold will be needed to see the effect. I still can not figure out why in vivo dose is far lower than the in vitro dose. Do need to monitor the heart rate when you use it.  

2mg/kg

Since 2008 I have treated 65 patients and monitored all closely in close collaboration with 2 pediatricians. for 2-5 years. I agree that a close monitoring is very important especially in the youngest children, for the first months. I have observed another 70 children with haemangiomas who we did not treat for some reason or another. Those without treatment we have seen 2 times per year. The youngest was 4 weeks old when treatment was started.

Dosage: Our average dose is 2 mg/kg. Propranolol mixture in the beginning then tablets as soon as possible  (mixed with the milk)

It is very important not to stop the treatment too early.

It is very interesting to read the comment from Dr Teng about the high culture dose needed to see effect!

Well, we usually are not starting such treatment for capillary haemangiomas in an age less than 3.5 years for the probability of spontaneous regression.  

2mg/kg

2-3 mg per kg on 3 divided doses

2 mg/kg/day in two divided doses after starting at half dose for one week. Trials have only shown an efficacy up to 26 weeks. Stop medications during fever and fasting, and measure pulse and BP regularly

It seems that different clinicians are using different dosages of propranolol from 1-3mg/kg/day in two or three divided doses. The question is, are we all getting the same response?

It's variable and dependent on the lesion and age. The faster growing lesions respond better and 10% spontaneously involute per year without treatment after age 1 year.

I wonder how many do TSH (for hypothyroidism) and a hepatic ultrasound for intrahepatic haemangiomas? Also how often do you obtain a formal eye review -- only with lesions close to or involving the eye?

We have not been measuringTSH. U/S liver in cases where infant has numerous cutaneous lesions, but very low pickup. Eye review in all cases where in visual field.

by chance I met this question.

in early childhood I had one haemangioma on the toe. It went away very fast after a local radiation (nuclear) treatment. Of course this works well only on the skin.

We use 2 mg/kg/day divided in 3 doses, at intervals of 7h during the day and 9h at night in order to avoid sleep disturbance problems. We have also used topic timolol 0.5% in periorbital/palpebral hemangiomas with good results.

We are using 2-3mg/kg/day in two divided dose,results are excellent in infantile haemangioma.

We first made cardiology evaluation of child , and first day start with 0,5 mg/kg divided in 3 doses, second day dose is 1 mg/kg divided in 3 doses, and third day we start with therapeutically dose 2 mg/kg divided in 3 doses. In one case we have 3 months old boy with subglotic haemangioma which disappeared after six months of treatment. 

We use 2-3mg/kg in 3 doses, also with very good results. The best results are in infants younger than 6 months, during the rapid growth of the hemangioma. No experience yet with topical beta-blockers. Ophtalmologic evaluation only in periocular lesions.

I use 0.5 mg /kg for 6-8 months with equally good results and reduced complications like hypoglycemia especially in smaller infants. I have never used topical beta blockers. No concurrent use of steroids.

Dear Sanjay, is that 0.5mg/kg per dose or per day?

For small babies our pediatricians begin with 0,2 mg/kg propranolol per day, gradually increasing to 1 mg/kg in two divide doses. Initially pulse, blood pressure and blood sugar monitor are monitored.

For older children I prefer to begin with 1 mg/kg per day with monthly increasing till 2 mg/kg twice daily, as a rule adding topical  Geltim (Timolol) Gel. Satisfactory effect is achieved for 8-12 months, depending on the type and size of the lesion.

But, one must not forget that the definitive cure of some treated in this way lesion requires final surgical excision.