[Dr.Vad]

вместо пропранолола внутрь, можно попробовать тимoлол-гель местно
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Timolol is a beta-blocker, which when used as an ophthalmic solution in the eyes can be absorbed
systemically. The summary of product characteristics for Timoptol-LA 0.5% warns that the same
types of cardiovascular, pulmonary and other adverse reactions seen with systemic beta-blockers
may occur when timolol used in the eyes is absorbed systemically, although the incidence of
systemic adverse reactions after topical administration in the eyes is lower than for systemic
administration.

Systemic absorption has also been shown with timolol used topically to treat infantile
haemangiomas. In a study by Weibel et al. 2012, in 24 infants (aged 2 to 35 weeks) with small
proliferating infantile haemangiomas who had urine analysis after timolol 0.5% gel was applied
twice daily with no occlusion, 20 tested positive for the detection of timolol. Serum levels were
measured in 4 infants resulting in a median value of 0.16 micrograms/L. The authors report that
these levels are lower than for ophthalmic administration, but caution that care is still required
particularly if topical timolol is being considered for extensive use in very young infants. A
commentary by McMahon et al. 2012 also cautions that using timolol near or on mucosal surfaces
(such as eye, mouth or anus) or thinner skin sites (such as perineum) or in areas of haemangioma
ulceration may further augment systemic absorption.