title: The Role of the Pharmacist in the Treatment of Patients with Infantile Hemangioma Using Propranolol.
abstract: Infantile hemangiomas (IH) are the most common benign vascular tumors of childhood, with an incidence of 5-10% during the first year of age. Propranolol is considered the first-line treatment for this condition. Potentially there is a high probability of negative results to therapy, because in many countries there are no treatment protocols or propranolol formulations appropriate for the pediatric population. The objective of the present study was to evaluate the impact of pharmacist interventions such as detecting, analyzing, and solving problems presented during treatment with propranolol in patients with IH.
  
  
  
  An open observational prospective study was performed over 25 months in a group of pediatric patients diagnosed with infantile hemangioma treated with propranolol. Pharmacist participation consisted of development of an extemporaneous formulation and counseling the child's parents. At each visit to the pharmacy service, family members were interviewed, detecting and classifying problems related to treatment.
  
  
  
  Sixty-three children with IH were treated during the period under review. Patient ages ranged from 3 to 11 months old; 64% were female and 36% were male. Forty-nine problems in 30 patients were detected, principally inadequate dose (18.4%), non-adherence to treatment (16.3%), side effects (14.3%), and wrong administration (14.3%). Of the problems detected, 81.6% were resolved. Interventions by the pharmacist in 27 patients were intensive counseling on adherence to therapy (20%), detection of adverse effects (11.4%), and adjustment of the dose (22.9%). In 95.2% of patients a good response to treatment was obtained compared with 77.2% reported in European studies without pharmacist intervention.
  
  
  
  It seems that pharmacist participation increases adherence to treatment and reduces the likelihood of adverse effects, allowing for safe and effective therapy in patients with IH.
authors.affiliation: Department of Pharmacy, Children's Hospital of the Californias, Tijuana, Baja California, Mexico. saulcashe@gmail.com.
authors.forename: Saul
authors.identifier: 0000-0002-2106-6098
authors.initials: S
authors.lastname: Castaneda
authors.affiliation: Faculty of Chemical Sciences and Engineering, Autonomous University of Baja California, Tijuana, Mexico.
authors.forename: Samuel
authors.initials: S
authors.lastname: Melendez-Lopez
authors.affiliation: Department of Pediatric Dermatology, Children's Hospital of the Californias, Tijuana, Mexico.
authors.forename: Esbeydy
authors.initials: E
authors.lastname: Garcia
authors.affiliation: Faculty of Chemical Sciences and Engineering, Autonomous University of Baja California, Tijuana, Mexico.
authors.forename: Hermelinda
authors.initials: H
authors.lastname: De la Cruz
authors.affiliation: Faculty of Chemical Sciences and Engineering, Autonomous University of Baja California, Tijuana, Mexico.
authors.forename: Jose
authors.initials: J
authors.lastname: Sanchez-Palacio
mesh_terms: D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000517:prevention & control; D005260:Female; D006391:Hemangioma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D007223:Infant; D008297:Male; D055118:Medication Adherence; D054539:Medication Therapy Management / Q000458:organization & administration*; D008800:Mexico / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000379:methods; D010595:Pharmacists; D024382:Professional Role; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D011433:Propranolol
keywords: Dermatology; Drug safety; Infantile hemangioma; Pediatric; Pharmaceutical intervention; Pharmacist; Propranolol