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Treatment of hemangioma with brand-name propranolol tied to fewer dosing errors


Key clinical point: Although more costly than generics, Hemangeol (Pierre Fabre) could reduce safety concerns for treating infantile hemangioma.

Major finding: Physicians prescribing generic propranolol had a higher rate of miscalculated dosing errors, 30%, compared with 10% prescribing the brand-name formulation.

Data source: Based on survey responses from 223 physicians, 70% of whom were pediatric dermatologists.

Disclosures: Dr. Siegfried is a consultant for Pierre Fabre and served as a principle investigator on phase 3 research. The company did not sponsor the current study, but a coauthor and employee of Pierre Fabre assisted with the logistics of the survey.


AT AAP 2017


– Among physicians using generic propranolol to treat infantile hemangioma, 30% reported at least one patient experienced a miscalculation dosing error, a new survey showed. Among respondents who prescribed Hemangeol (Pierre Fabre Pharmaceuticals), 10% reported a similar error. The errors were made by either a provider or caregiver.

Confusion may have contributed to a second source of errors, said Elaine Siegfried, MD, professor of pediatrics and dermatology at St. Louis University in Missouri. Generic propranolol is supplied as a 20-mg/5-mL oral solution and a 40-mg/5-mL oral solution. “Any time you have more than one formulation, it’s a nidus for dispensing error by the pharmacy.”

Dr. Elaine Siegfried professor of pediatrics and dermatology
Dr. Elaine Siegfried
“That’s what I noticed. I make people bring in their medicines to check that, because I know dispensing errors are common,” Dr. Siegfried said in an interview following a presentation at the annual meeting of the American Academy of Pediatrics.

“So if a doctor prescribes [the lower dose], which is what we always do for safety, and they get 40 [mg], the [patient] can become hypoglycemic, hypotensive, or bradycardic,” Dr. Siegfried said. “That’s not good.”

Dr. Siegfried and colleagues assessed survey responses from 223 physicians. The majority, 90%, reported prescribing generic propranolol to treat infantile hemangioma in the past. Sixty-percent reported also prescribing the brand name formulation approved by the Food and Drug Administration in 2014. Most of those who completed the survey, 70%, were pediatric dermatologists; general dermatologists, pediatric otolaryngologists, and other specialists also participated.

A total of 18% of physicians surveyed reported a dispensing error associated with use of generic propranolol. Dr. Siegfried said such errors are not possible with the branded formulation because it is available only in a single concentration, a 4.28 mg/mL oral solution. She added that one central specialty pharmacy dispenses Hemangeol, further reducing the likelihood of errors.
Wikimedia Commons/Zeimusu/Public Domain


Addressing cost concerns

“When this [branded] drug became available, I wondered why everyone was not prescribing it,” Dr. Siegfried said.

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